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C)NSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 <br /> BION-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES ') YEAR FROM DATE ISSUED <br /> FOWNER <br /> SS J <br /> CITY/ZIP <br /> EET /� h <br /> APN M7 j 7 ©'3 PARCEL SIZE /d( <br /> ME a�( Y� a� o <br /> PHONE__ <br /> OWNER ADDRESS SGC7 ?�yl�ln> CITY/STATE/ZIP <br /> CONTRACTOR—� 1J C iL <br /> PHONE <br /> CONTRACTOR ADDRESS CITY/STATE/ZIPC ✓ <br /> LICENSE ❑P6-42 110C-36 OTHER NUMBER EXPIRATION DATE OV_ZO�Z/ <br /> WATER TABLE DEPTH: `' ft GEOGRAPHICAL INFORMATION: Coordinates X <br /> Y <br /> ElPERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION REPAIR/ADDITION <br /> ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION fa N k <br /> INSTALLATION WILL SERVE: j9,RESIDENCE ❑ COMMERCIAL Niarce <br /> NUMBER OF LIVING UNITS: P E) OTHER <br /> NUMBER OF BEDROOMS: a iA6"' IJI0T) NUMBER OF EMPLOYEES: <br /> SEPTIC TANK TYPE/MFG CAPACITY <br /> [� GREASE TRAP TYPE/MFG �� gal #OF COMPARTMENTS_ <br /> CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE_TO NEAREST: WELL /00 ' ft FOUNDATION 5, O ft PROPERTY LINE su >" <br /> ❑I LIFT STATION SIZE ft <br /> -- TYPE OF PUMP_ ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> {�- LEACH LINES LEACHING CHAMBERS_ #OF LINES _ LENGTH OF LINES S� ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE <br /> ® FILTER BED WIDTH ft <br /> ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE <br /> ® MOUNDED WIDTH ft <br /> ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> SUMPS WIDTH 69$ — ft LENGTH /'Y' ft DEPTH '16 .1 ft <br /> DISTANCE TO NEAREST WELL /5-0' ft FOUNDATION /6�y ft PROPERTY LINE ft <br /> U DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH I <br /> 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 PIAVE 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 TITLE DATE Z ' <br /> v � <br /> f <br /> -————————— — — ———————————— <br /> + V,J <br /> ---------- <br /> U <br /> --- <br /> R <br /> DEPARTMEN USE ONLY <br /> Application Accepted B Date � as ,0010 Area y �� Employee ID#D <br /> Final Inspection By Date 5 Zw SPECIAL PERMIT-Approved by iv <br /> Character of Soil to Depth of 3 F : Pit/Sump Soil)anacter: <br /> COMMENTS <br /> ! C/� ld4eea, 2`X l Y S 1Y o' L <br /> Z ! S [o xZ <br /> PE SC Received he Amoun Date Permit/ <br /> Code INFO B C Remitted ervice Request# Invoice# Permit ID# <br /> �la�� ins Z3a� Co i 2 <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />