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UN01 I t VVAb I tVVA I the I KtA I MtN I SYS I EM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 95202-(209)468.3420 <br /> NON-REFUNDABLEPERMITCALL 209 953-7697 FOR INSPECTIONS���� EXPIRES I YEAR <br /> FROM <br /> DATE ISSUED <br /> -t IY <br /> JOB ADDRESS -/.- S. PI�j S- EST P-4--'>. CCITY/Zip :F YG� ctlytl )5-La t y <br /> ./ � 4 <br /> 7 5- <br /> CROSS STREET W"1 � P'a APN "1 7'Z 2� I PARCEL SZE •`�' > <br /> 0 <br /> OWNER NAME KuSpt i✓ACCK/''c(2-I Gf7 R-P, PHONE�Ij 7-13^91q 2- <br /> OWNER <br /> OWNER ADDRESS' S �A✓ CrrY/STATE/ZIP <br /> CONTRACTOR LIVE lJ�l�1� � p�VI��NmEJVTP�L PHONE �� <br /> CONTRACTOR ADDRESSy I W Ur '1 - CITY/STATEIZIP L- �^\ -1 2--C�/'0 <br /> LICENSE ❑C-42 ❑,C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST # ZBUILDING PERMIT# LAND USE APPLICATION# 19A--I k O01-I <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS ✓�E� <br /> ElGREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS CZ T <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE /I eD <br /> C] LIFTSTATION SIZE TYPE OF PUMP C3PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM)A <br /> ? 2019 <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES Q� <br /> H lly CQ <br /> DISTANCE To NEAREST WELL ft FOUNDATION ft PROPERTY LINE FAC]ry.� O MEIv]•(�N 7Y <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft _P�TIb(NT <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH It DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It <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 It <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 /> INIM 4 OUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED TITLE C 67,)SVZ- PVr r DATE -1 -31) -) 9 <br /> PROPERTY LINE 738.5' <br /> 2 <br /> e.n.,tl wsw� rn <br /> o }•+ \ ________ _ n <br /> 0 -- ------ -- - ...n ---------'--i OD <br /> .. F� <br /> w <br /> H W <br /> Z <br /> .. L___________J im ` <br /> It <br /> 0. <br /> a rc I <br /> ®M <br /> PROPERTY LINE 738.5 <br /> DEPARTMENT SE ON Y /1 <br /> Application Accepted By Date ' / ✓ Area // Employee ID# <br /> Final Inspection By Date / ❑ SPE4C�AL�E&IT-Approved by <br /> Character of Soil to Depth of 3 Ft: t Pit/Sump Soil Characteq <br /> COMMENTS 0 <br /> PE Sc Received Chec Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO By as Remitted Service Request <br /> �7 <br /> L p <br /> a2-01 / ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />