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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 CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS L 0 I!J E, ,5 'I' ,2 CITY/ZIP ClernP%'1 fJ <br /> CROSS STREET : Y) h W J APN /[eJ a ,�o� b b S" PARCEL SIZE m <br /> OWNER NAME MrxriG ci'el CCt r nl eyt -t eZ./I�a1VLt/I7914 1'2'9f/Nc .0 E��-(y�/.33��7o <br /> OWNER ADDRESS CC 72, � CITYISTATEIZIP 1✓ f��/���� <br /> CONTRACTOR V�h er' PHONE <br /> CONTRACTOR ADDRESS CITY/STATE/ZIP <br /> LICENSE LI-C-42 ❑_C-336 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: I ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION _ REPMR/ADDITION ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT _ OUT-OF-SERVICE SEPTIC SYSTEM _ DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL L OTHER <br /> �y NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> IY SEPTIC TANK TYPE/MFG CAPACITY D�O gal #OF COMPARTMENTS--- <br /> L3 <br /> OMPARTMENTS❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION It PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP O PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES C LEACHING CHAMBERS #OF LINES LENGTH OF LINES C& <br /> DISTANCE TO NEAREST WELL 10D ft FOUNDATION_ ft PROPERTY LINE (09 aw" <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 It FO NDATION ft PROPERTY LINE ft <br /> SUMPS WIDTH Z ft LENGyi ft DEPTH / ft <br /> DISTANCE TO NEAREST WELL /��ft FOUNDATION ft PROPERTY LINE ft <br /> 09F69ttj0jj SWID / E ft <br /> DISTANCE TO KE F UNDATIO ft PROPERTY LINE ft <br /> I SEEPAGE PITS NUMBER TH ft <br /> DISTANCE TO NEAREST WELL <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 V NOTICE REQUIPED FOR INSPECTIONS-PLEASE CALL 2 9E3-769 <br /> SIGNED TITLE �,tti'?f,� DATE 12 <br /> ell AYI►�ENT <br /> ECEIVED <br /> R 18 202, <br /> Ali <br /> AQUIN COUNTY <br /> IRONMENTAL <br /> DEPgRTMENT <br /> / // DEPARTMENT US ONLY 1 <br /> Application Accepted By Z-1 L_ Date d 1 Area C 'o Employee ID# <br /> Final Inspection By to /o (K Lp l.� ❑ SPE IAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: it/Sump Soilharacter: <br /> COMMENTS f ,-� /fie til (' 'f2 F►' 1( ��c ;.Its I�� !t +�� SF t a,c k-S <br /> PE SC Received Check#/ Amount Dat Permit/est # Permit ID# <br /> Code INFO Remitted Service Re uest# <br /> �) 1S 21 , <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />