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ONSITE "SIASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET - STOCKTON CA 95202 - (209) 468-3420 <br />NON-KEFUNDABLE PERMIT ,r /� �(� [ CALL (,.2,09) 953-7697 FOR INSPECTIONS � yEXPIRES 1 YEAR FROM DATE ISSUE <br />JOB ADDRESS 347- r C •QI��Ir\F-i F,&O(N CITY21P " r/c--'Ta NJ ,Q-�.. <br />CROSS STREET (""''/ L• �I`� �.,` APN r - PARCELSVE c�33 , "• <br />�� <br />OWNER NAME i gAllic )SCO / pG�VEZ PHONE <br />OWNER ADDRESS S A tM E CITY/STATE/ZIP^� Jam, 7 <br />CONTRACTOR LICE DDIA^17� �Eb EQM�i K(On►rhENT�t L PHONE 1P I -o39-f' <br />q•� <br />CONTRACTOR ADDRESS 'iy `t W • O � � F'- " 1 CITY/STATE/ZIP t -o ✓ I CA ` J z-y4o <br />LICENSE I IC -42 IC -36 OTHER NUMBER EXPIRATION DATE <br />WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br />PERC TEST # <br />) BUILDING PERMIT # <br />C LEACHING CHAMBERS <br />LAND USE APPLICATION # <br />TYPE OF WORK: <br />-, NEW INSTALLATION 7 <br />REPAWADDITION <br />-, ENGINEER DESIGNED /ALTERNATIVE <br />DISTANCE TO NEAREST WELL <br />REPLACEMENT <br />_ DESTRUCTION <br />INSTALLATION WILL SERVE: -1 RESIDENCE <br />_! COMMERCIAL <br />OTHER <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: <br />NUMBER OF EMPLOYEES: <br />❑ SEPTIC TANK <br />TYPE/MFG <br />CAPACITY <br />gal # OF COMPARTMENTS <br />❑ GREASE TRAP <br />TYPE/MFG <br />CAPACITY <br />gal # OF COMPARTME <br />DISTANCE TO NEAREST: WELL <br />ft FOUNDATION <br />ft PROPERTY LINE <br />❑ LIFT STATION <br />SIZE TYPE OF PUMP <br />LlPKG TX PLANT <br />13SAND OIL SEPARATOR (EIIII3SY&W <br />Application Accepted By <br />Final Inspection By <br />Character of Soil to Depth of 3 Ft: <br />COMMENTS <br />DEPARTMEN_ T USON Y <br />i <br />Data Area <br />Date C SPECIAL PERMIT <br />Pit/Sump Soil Character: <br />EmployeeID# 'l <br />Approved by <br />rMENT <br />:EIVen <br />30 2019 <br />UIN COUNTY <br />PE SC Received <br />LEACH LINES <br />C LEACHING CHAMBERS <br /># OF LINES , <br />LENGTH OF LINES <br />i <br />• <br />Service Re uest# <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION <br />ft PROPERTY LINE <br />It <br />❑ FILTER BED <br />WIDTH ft LENGTH <br />ft <br />DEPTH <br />ft <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION <br />ft PROPERTY LINE <br />ft <br />❑ MOUNDED <br />WIDTH It LENGTH <br />ft <br />DEPTH <br />ft <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION <br />ft PROPERTY LINE <br />ft <br />WIDTH ft LENGTH <br />ft <br />DEPTH <br />ft <br />������ <br />{•_ski <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION <br />ft PROPERTY LINE <br />ft <br />V 1�J�JS <br />WIDTH ft LENGTH <br />ft <br />DEPTH <br />ft <br />PAGE PITS <br />DISTANCE TO NEAREST WELL <br />NUMBER WIDTH <br />ft FOUNDATION <br />ft <br />ft PROPERTY LINE <br />DEPTH <br />ft <br />ft <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION <br />ft PROPERTY LINE <br />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 <br />REGULATIONS OF SAN JOAQUIN COUNTY. <br />I 1 44 HOUR ADVANCE NOTICE REQUIRED <br />FOR INSPECTIONS - PLEASE CALL (209) 953-7697 <br />SIGNED <br />I � <br />TITLE GaIfS✓LT M—T- <br />G <br />DATE <br />Application Accepted By <br />Final Inspection By <br />Character of Soil to Depth of 3 Ft: <br />COMMENTS <br />DEPARTMEN_ T USON Y <br />i <br />Data Area <br />Date C SPECIAL PERMIT <br />Pit/Sump Soil Character: <br />EmployeeID# 'l <br />Approved by <br />rMENT <br />:EIVen <br />30 2019 <br />UIN COUNTY <br />PE SC Received <br />heck#/, <br />Amount <br />Date Inv rt <br />Permit/Code <br />INFO BCash <br />Remitted <br />Service Re uest# <br />q2zz- 52A Lt <br />4,l L -7 6 <br />r) <br />3c 1 <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />