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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 NON-KEFUNDABLE PERMIT GALL ZUY YOJ-1091 FOR INSPECTIONS tXPIRES l YEAR FROM UAT/E ISSUEI JOB ADDRESS gal # OF COMPARTMENTS �S N ,�/� CITY/ZIP / • •C-4 7(,LcA ( GA / S 3 3 V CROSS STREETlypl, gal # OF COMPARTMENTS / 2 APN ��vJ PARCEL SIZE 5�! OWNER NAME amqIV i Rctvacn Dewefr PHONE �I�n—�L(rj'+�V_T, OWNER ADDRESS ❑ PKG TX PLANT CITY/STATE/ZIP fr lq I I Pr i p I :rl�j g�oZ S� CONTRACTOR f IS r (n _e- 1 PHONE 4 15�6anG s - CONTRACTOR ADDRESS P6 VA �J V, CITY/STATE/ZIP MQq A1t4s+r GiA' LICENSE ❑ C-42 0'._'C-36 OTHER NUMBER�Omq EXPIRATION DATE � ;�3 _ ft DEPTH ft WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION (. REPAIR/ADDITION I ENGINEER DESIGNED /ALTERNATIVE REPLACEMENT OUT -0F -SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: U14ESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: I NUMBER OF BEDROOMS: -3 NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPE/MFG CAPACITY gal # OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS DISTANCE TO NEAREST DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. MINIMUM 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-Y697. DEPARTMENT USE ONLY Application Accepted By L� Z L Date�(�/,? I Area 3 Employee ID# Final Inspection By Date II Z L 2t)ZA_ ❑ SPECIAL PERMIT -Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS �-AI�yS4ekr, ��,"C;I) i,ITi�r b l'r�ubj)� SF�vJcg►'nv� ��rr�le��f cbf Pew PE SC Received Code INFO By LEACH LINES LEACHING CHAMBERS y a» � ►� # OF LINES LENGTH OF LINES 0 a I ft DISTANCE TO NEAREST WELL�� ft FOUNDATION (01 ft PROPERTY LINE sl ft ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. MINIMUM 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-Y697. DEPARTMENT USE ONLY Application Accepted By L� Z L Date�(�/,? I Area 3 Employee ID# Final Inspection By Date II Z L 2t)ZA_ ❑ SPECIAL PERMIT -Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS �-AI�yS4ekr, ��,"C;I) i,ITi�r b l'r�ubj)� SF�vJcg►'nv� ��rr�le��f cbf Pew PE SC Received Code INFO By Check#/ C Amount ate Permit/ Invoice # Permit ID# Remitted Service Request # y a» � ►� �� 'I i3 s ss 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18