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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 4683420 <br />NON-REFUNDABLE HERMIT GALL (ZU',!J `J93 -/Dy/ FUR INSPECTIONS LXPIRES 1 YEAR FROM UATE ISSUEI <br />JOB ADDRESS 311, p& C) •, Pi� 1� N C' F -T> CRY/ZIP L D D 1 9 5 l `{-D <br />CROSS STREET /yIt �`^j A, p APN L)m9-- C'�0-33 PARCEL <br />1SIIZZ IE 5 -'op <br />OWNER NAME ASA 11>AV F1 PHONE 701) 7(01 - 4130 <br />OWNER ADDRESS S pf w1 E / l- G 1,p CITY/STATE21P L <br />CONTRACTOR Lti V kr D A KG- E:0 e,/JV 11e0 NN't CAjT t`\ L- PHONE 3 LP l <br />CONTRACTOR ADDRESS L40-1 w. 0 ML 'ST' �f 1 CRY/STATE/ZIP LLD t C'A <br />LICENSE EPC -42 ❑L'.0-36 OTHER C I< V' NUMBER N I EXPIRATION DATE 4-30-Z2 <br />WATER TABLE DEPTH: <br />ft GEOGRAPHICAL INFORMATION: Coordinates X <br />Y <br />PERC TEST # <br />1 BUILDING PERMIT # <br />LAND USE APPLICATION # <br />TYPE OF WORK: <br />U NEW INSTALLATION ❑ <br />REPAIR/ADDITION <br />❑ ENGINEER DESIGNED/ALTERNATIVE <br />WIDTH <br />REPLACEMENT ❑ <br />OUT -OF -SERVICE SEPTIC SYSTEM <br />0 DESTRUCTION <br />INSTALLATION WILL <br />SERVE: ❑ RESIDENCE <br />❑ COMMERCIAL <br />❑ OTHER <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: <br />NUMBER OF EfiPLOYEES: <br />WIDTH <br />ft LENGTH <br />ft DEPTH ft <br />❑ SEPTIC TANK <br />TYPE/MFG <br />CAPACITY <br />gal # OF COMPARTMENTS <br />❑ GREASE TRAP <br />TYPE/MFG <br />CAPACITY <br />gal # OF COMPARTMENTS <br />I <br />DISTANCE TO NEAREST: WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ LIFT STATION <br />SIZE TYPE OF PUMP <br />❑ PKG TX PLANT ❑ <br />SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />❑ LEACH LINES <br />J LEACHING CHAMBERS <br /># OF LINES <br />LENGTH OF LINES It <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ FILTER BED <br />WIDTH <br />ft LENGTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />It FOUNDATION <br />ft PROPERTY LINE It <br />❑ MOUNDED <br />WIDTH <br />ft LENGTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ SUMPS <br />WIDTH <br />ft LENGTH <br />It DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ DISPOSAL PONDS WIDTH <br />ft LENGTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ SEEPAGE PITS <br />NUMBER <br />WIDTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />It FOUNDATION <br />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 <br />AND RULES AND <br />REGULATIONS OF SAN JOAQUIN COUNTY. <br />MINIMUM <br />WUR ADY4NfaE NOTICE <br />RE <br />IRED FOR INSPECTIONS - PLEASE CALL (2 09) 953-7697 <br />SIGNED <br />TITLE p/LVJ • <br />✓1'1 QR-' DATE "t' 91 ` Z 1 <br />a <br />m <br />COMMENTS <br />PE SC Received Check#/ Amount ate Permit/ Invoice # Permit ID# <br />Code INFO ash Rem' Service Request # <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4/14/18 <br />=IVT <br />VED <br />2021 <br />COUNTY <br />ENTAL <br />RTMENT <br />