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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1666 E. HAZELTON AVENUE -STOCKTON CA 95205 - (209) 468-3420 <br />IYUN-nthUNUAC,L`L YtHMMII I �p GALL (ZUyJYDJ-/0`J/ FOR INSPECTIONS p.,�E�XPIRES 1 YEAR FROM DATE ISSUEI <br />JOB ADDRESS 4 �1 (� Qyei; F �• CITY/ZIP <br />Ac-t t 0 41 S -x'-0 <br />CROSS STREET Trf W 4TH -I -1 E• T �� 6-C AP O ( _I - 0 -0 " UkQ PARCEL SIZE 0 • ( S�(�� <br />OWNER NAME ILC(1 -+ �e:Cje-F-2 PHONE t��) 40-1-q3 0 <br />OWNER ADDRESS 3368 �,. T`�-��'�O . CITY/STATE/ZIP A--ew%-go cA IS-1Zo <br />CONTRACTOR LINt Ot-�"v­ GE0EnNl2pNmEN ISL PHONE <br />CONTRACTOR ADDRESS -CO-1 W • OAK Ste' CITY/STATE/ZIP Le -pt CA 9 's -L f o <br />LICENSE ECC -42 111'',C-36 OTHER C Ey NUMBER 7-15.1 EXPIRATION DATE 44 _3 Q -ZZ <br />WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br />T <br />❑ LEACH LINES <br />PERC TEST # <br />I BUILDING PERMIT # <br /># OF LINES <br />LAND USE APPLICATION # <br />TYPE OF WORK: <br />., NEW INSTALLATION <br />REPAIR/ADDITION <br />I; ENGINEER DESIGNED/ALTERNATIVE <br />ft FOUNDATION <br />.. REPLACEMENT ... <br />OUT -OF -SERVICE SEPTIC <br />SYSTEM I] DESTRUCTION <br />INSTALLATION WILL SERVE: 0 RESIDENCE <br />D COMMERCIAL <br />G OTHER <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: <br />DEPTH ft <br />NUMBER OF EMPLOYEES: <br />❑ <br />SEPTIC TANK <br />TYPE/MFG <br />CAPACITY <br />gal # OF COMPARTMENTS <br />❑ <br />GREASE TRAP <br />TYPE/MFG <br />CAPACITY <br />gal # OF COMPARTMENTS <br />ft <br />DISTANCE TO NEAREST: WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ <br />LIFT STATION <br />SIZE TYPE OF PUMP <br />O PKG TX PLANT <br />O SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />❑ LEACH LINES <br />LEACHING CHAMBERS <br />ate Permit/ Invoice # Permit ID# <br />Service Request # <br /># OF LINES <br />LENGTH OF LINES ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ FILTER BED <br />WIDTH <br />ft <br />LENGTH <br />ft <br />DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ MOUNDED <br />WIDTH <br />ft <br />LENGTH <br />ft <br />DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ SUMPS <br />WIDTH <br />ft <br />LENGTH <br />It <br />DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE It <br />❑ DISPOSAL PONDS WIDTH <br />ft <br />LENGTH <br />ft <br />DEPTH It <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 />ft FOUNDATION <br />ft PROPERTY LINE It <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 />Application Accepted By �"L— Date '-11,3 Area `I / LI 4'1 Employee ID# f ��- <br />Final Inspection By Date 02 JPU ❑ SPECIAL PERMIT - Approved by <br />Character of Soil to Depth of 3 Ft: Pit/SuTp Soil Character: <br />COMMENTSIH'..�.I r� <br />PE SC Received ec Amount <br />Code INFO B ash Remitted <br />ate Permit/ Invoice # Permit ID# <br />Service Request # <br />Llaaa sa s- <br />g \"1 <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4/14/18 <br />