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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-KEFUNDABLE PERMIT CALL IZUyI 90,f -/6y/ FOR INSPECTIONS tXPIRES 1 YEAR FROM UATE ISSUEI <br />JOB ADDRESS .7 Il % rill- Wo 0 C44-0vn tLod C,/ CITY/ ZIP 1Af'C�/wrffm <br />CR <br />% <br />I) <br />CROSS STREET t� R11 IN( N r kj Q �ii / ) APIN �`J � � �t i/I � PARCEL SIZE . 76 <br />OWNER NAME �� � J V �'� � Cc N r PHONE <br />OWNER ADDRESS'L�M'F / CITY/STATE/ZIP �" r7r <br />CONTRACTOR QUIT ✓ / C / PHONE ao 5C-f3�V�/�sd / / <br />CONTRACTOR ADDRESS 37 CITY/STATE/ZIP S�C.�, 15-d <br />r <br />LICENSE ❑I -42 ❑'. �C-36 OTHER NUMBER,/ r9y l J EXPIRATION DATE <br />WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br />❑ <br />PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # <br />TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED /ALTERNATIVE <br />HaID <br />REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION <br />INSTALLATION <br />WILL SERVE: RESIDENCE COMMERCIAL _ OTHER <br />NUMBER OF LIVING UNITS: I NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br />❑ <br />L <br />SEPTIC TANK TYPE/MFG C.rG Or7 !M /CTI -'ek- CAPACITY gal # OF COMPARTMENTS <br />❑ <br />GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS <br />DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br />❑ <br />LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />4{0 ' <br />LEACH LINES LEACHING CHAMBERS # OF LINES C;� LENGTH OF LINES ft <br />DISTANCE TO NEAREST WELL /400 / ft FOUNDATION ft PROPERTY LINE �$ / ft <br />❑ <br />FILTER BED WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />❑ <br />MOUNDED WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />❑ <br />SUMPS WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />❑ <br />DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />j( <br />Jif <br />SEEPAGE PITS NUMBER WIDTH 3 / ft DEPTH -7-5-" ft <br />y <br />DISTANCE TO NEAREST WELL ft FOUNDATION /00/ ft PROPERTY LINE 5 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 AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br />MINIMUM 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS -PLEASE CALL 209 953-7697 <br />SIGNED <br />4' l TITLE111041br u G///V- DATE <br />.�--y DEPARTMEN U E ONLY "JZP 'ti <br />Application Accepted By Date Area Employee ID# <br />Final Inspection By - !.'.- 1 L S (� C s ,! Date lU� �.l Zu£ I C SPECIAL PERMIT -Approved by <br />Character of Soil to Depth of 3 Ft: L Pit/Sump Soil Character: <br />COMMENTS f �ti�lY'�. SiiSTek1l?. �,p,5t;n� for G,r,C�FiY afJrn, SYSfi n'► C,sf,�4 �1%yrs �i <br />PE <br />Code <br />SC <br />INFO <br />Received hec Amount Date Permit/ <br />By- Cash Remitted Service Request # <br />Invoice # Permit ID# <br />HaID <br />HS; <br />&.2q, ZI k0 � 13 <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4/14/18 <br />T <br />