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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 PERMIT J STALL (209) 95,/3�- 76697 FOR INSPECTIONS ` / /EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS ��, J � 3!�LCJZ , 76 <br /> ,1i CITY/ZIP sT rof f> �sa� s Cr <br /> CROSS STREET litJeo/ APN l s I D O <br /> PARCEL SIZE p <br /> _ / O <br /> OWNER NAME llc' .4 /wtglly /�C AJ PHONE 3Z/ — (obi C1 .4� v <br /> OWNER ADDRESS 5 e]L22,y CITY/STATE/ZIP <br /> CONTRACTOR / ,7 �i�e '19zref/�/�t/ J �c� PHONE <br /> CONTRACTOR ADDRESS ��7 (cUul� /Y P? ��/l/� I�/� CITY/STATE/ZIP � vci <br /> LICENSE ❑X42 ❑ ❑ C-36 OTHER NUMBER EXPIRATION DATE (j 1•3c% %ZG <br /> WATER TABLE DEPTH : ft GEOGRAPHICAL INFORMATION : Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT # r f r % LAND USE APPLICATION # <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED /ALTERNATIVE <br /> ❑ REPLACEMENT ❑ OUT-OF-SERVICE SEPTIC SYSTEM ❑ DESTRUCTION /�, <br /> INSTALLATION WILL SERVE : 11 RESIDENCE 11 COMMERCIAL � OTHER 1377/.9 �1T <br /> NUMBER OF LIVING UNITS : / NUMBER OF BEDROOMS : ( NUMBER OF EMPLOYEES : <br /> ❑ SEPTIC TANK TYPE/MFG CAPACITY gal # OF COMPARTMENTS <br /> woe <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS <br /> DISTANCE TO NEAREST : WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR ( ENCLOSED SYSTEM ) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS %V/ ,54;"V � # OF LINES Joe �/ LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL Z:.�r f ft FOUNDATION /10 ft PROPERTY LINE �UG "� 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 /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft / FOUNDATION ft PROPERTY <br /> -•LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH () ft DEPTH ) ft <br /> DISTANCE TO NEAREST WELL 76& i ft FOUNDATION 16 ft PROPERTY LINE J�i`> ,f 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 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS <br /> - PLEASE CALL (209) 953- 7697 <br /> SIGNED TITLE /2 f!/�= DATE 0 <br /> i <br /> / r <br /> I X <br /> I % 1c;1 1ALwa <br /> A uN <br /> Er <br /> IV I <br /> N <br /> DEPARTMENT USE O LY l � , <br /> Application Accepted By Date I? Area U I Employee ID# <br /> Final Inspection By . Date 202 ❑ SPECIAL PERMIT - Approved by <br /> Character of Soil to Depth of 3 Ft : Pi Sump Soil Character: <br /> COMMENTS I C i /1 ; "ijA <br /> PE SC Received heck#/ Amount Date Permit/ Invoice # Permit ID# <br /> Code INFO By Cash Remitted 1 0 Service Request # <br /> 59 4 <br /> � � <br /> 42-01 Dc Ue ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/ 18 <br />