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ti <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 <br /> NON-REFUNDABLE <br /> /PERMIT M yCALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS ! 3 1 1 71 I vj-SIA/ po CITY/ZIP tC0<✓`) IC.*+ <br /> //�� <br /> to <br /> CROSSSTREET �Qfrol /401WAt." go APN (3-1,J a (7�� PARCEL SIZE p <br /> OWNER NAME <br /> A 0 <br /> y, ) l� A <br /> �� ��T(� -`Y�drt`'t — A- PHONE_ �r <br /> OWNER ADDRESS SC-1064._ CITY/STATE/ZIP <br /> CONTRACTOR 3f'Y\iG/� PHONE '( 5Gi-'a i&'r- <br /> CONTRACTOR <br /> A <� <br /> CONTRACTOR ADDRESS I •� '6 S� �CITY/STATE/ZIP C +7 Ne,4 � S <br /> LICENSE 111.-IC-42 ECIC-36 OTHER NUMBER 'S���I EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> E PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: LI NEW INSTALLATION REPAIR/ADDITION '.l ENGINEER DESIGNED//ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM +e DESTRUCTION 44VI K <br /> INSTALLATION WILL SERVE: f i ESIDENCE E COMMERCIAL E OTHER <br /> NUMBER OF LIVING UNITS: ( NUMBER OF BEDROOMS:-3 NUMBER OF EMPLOYEES: <br /> 011-SEPTIC TANK TYPE/MFG / )"y CAPACITY ��p '� c1 gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL_l,�n Y ft FOUNDATION 56 ft PROPERTY LINE SO f ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> 3/ LEACH LINES LEACHING CHAMBERS #OF LINES `, LENGTH OF LINES3�� ft <br /> DISTANCE TO NEAREST WELL �� ft FOUNDATION 'I.Sft PROPERTY LINE 40' ft <br /> FILTER BED WIDTH ft LENGTH ft DEPTH_ ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ll' SUMPS > y WIDTH r;- ft LENGTH / t ft DEPTH 10 r ft <br /> J /\ DISTANCE TO NEAREST WELL If SD' ft FOUNDATION 7.r t ft PROPERTY LINE -951 ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM 48 HOVR ADVANCE NOTICE REQUIRED FOR INSPECTIONS- PLEASE CALL 209 953-7697 <br /> SIGNED TITLE t.OAiN� �� _ DATE It <br /> +0 <br /> f D <br /> P JOA0 <br /> O R CUJ�, <br /> P A <br /> T <br /> DEPARTMENT USE ONLY <br /> ID# <br /> Application Accepted Bav-� <br /> Date Z U Area Employee <br /> Final Inspection By Date E SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS S' o I' 0 e : ern) t'Dus legal `e f`ir+l ie-iw 2.y, Al rases d— <br /> „coed 6 C1� Cord's e C D. Pev;rl3- rcnC>l <br /> bV Cfselr ell i-11�. or II `%a9R2 pet 1filke ui1ef Pel,J 44nk 31��c tires �nc/s�m <br /> PE SC Received -CfieckW Amount Permit/ Invoice# Permit ID# <br /> Code INFO B Remitted Date Service Request# <br /> `fZlj c5 <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />