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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 <br /> y� CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS/`1�1D / ��W n", GT CITY/ZIP <br /> CROSS STREET APN �13a SODo� PARCEL SIZE p <br /> y � O <br /> OWNER NAME '�L�171 _ I.JU�]'G"S ef-1 ��ca1�G�� PHONE <br /> OWNERADDRESS <br /> S 41,10 . CITY/STATE/ZIP <br /> CONTRACTOR /�G!14TXJ/�L_ PHONE '36x-1-SoZ7 �J� <br /> CONTRACTOR ADDRESS �/ 7(O / fJ!/r 7J�i�G I�iZ CITY/STATE/ZIP <br /> LICENSE ❑[x-42 ❑CIC-36 OTHER NUMBER—'4/- S UyS EXPIRATION DATE 09131 <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION REPAIR/ADDITION 'J ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: ML RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFGCAPACITY ��7�CiV gal #OF COMPARTMENTS Z <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 a LEACHING CHAMBERS ld #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL AJVVC_ ft FOUNDATION 401 <br /> ft PROPERTY LINE yo 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 /> 51, SUMPS WIDTH 9 ft LENGTH -a, ft DEPTH /40 , ft <br /> DISTANCE TO NEAREST WELL A&2IG. ft FOUNDATION ft PROPERTY LINE 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 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 <br /> SIGNED TITLEDATE O <br /> f <br /> cc <br /> F <br /> L O <br /> T <br /> T DEPARTMEN USE ONLY o� F�!/r <br /> Application Accepted ` ��z Date ?�Jv� Area '1 C Employee ID# A <br /> Final Inspection By17 Date G SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: f 1341,13-imp Soil Character: <br /> COMMENTS al jrl b 'PY S I c, <br /> 111 <br /> PE Sc Received heck#/ Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO '13V Remitted Service Request# <br /> ya►c, Ns- fX00 <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />