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r . <br />ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 <br />NON-REFUNDABLE PERMIT <br />` ` � CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 EAR FROM UATE ISSUE[ <br />JOB ADDRESS J F� *3 'y k/,V %P"-- y': _ CITY/ZIP \ ` e <br />CROSSSTREETC�.F �r�E� /J� APN f-2 S701 F ID -7 -G PARCEL SIZE <br />OWNER NAME �] `Z.C��t����1 PHONE <br />Q 1 � <br />OWNER ADDRESS 11157 11� 10y Z Z� 1 " t V ` - CITY/STATEIZIP '% O i� lawk 95 3 Ca cP <br />CONTRACTOR 0 ,Q N PHONE 7 ^ q !!5 — I OS <br />CONTRACTOR ADDRESS CITY/STATE/ZIP <br />LICENSE DDC -42 [IOC -36 OTHER NUMBER EXPIRATION DATE <br />WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br />❑ PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # <br />TYPE OF WORK: O NEW INSTALLATION ,_I REPAIR/ADDITION ❑ ENGINEER DESIGNED /ALTERNATIVE <br />0 REPLACEMENT 7 OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION C <br />INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br />❑ SEPTIC TANK <br />TYPE/MFG <br />CAPACITY <br />gal # OF COMPARTMENTS <br />Amount <br />Remitted <br />❑ GREASE TRAP <br />TYPE/MFG <br />CAPACITY <br />gal # OF COMPARTMENTS <br />Llaa� <br />o7s" <br />DISTANCE TO NEAREST: WELL <br />ft FOUNDATION <br />ft PROPERTY LINE <br />ft <br />❑ LIFT STATION <br />SIZE TYPE OF PUMP <br />❑ PKG TX PLANT <br />❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />❑ LEACH LINES <br />0 LEACHING CHAMBERS <br /># OF LINES <br />LENGTH OF LINES <br />ft <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION <br />ft PROPERTY LINE <br />ft <br />❑ FILTER BED <br />WIDTH ft LENGTH <br />ft DEPTH <br />ft <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION <br />ft PROPERTY LINE <br />ft <br />❑ MOUNDED <br />WIDTH ft LENGTH <br />ft DEPTH <br />ft <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION <br />ft PROPERTY LINE <br />ft <br />❑ SUMPS <br />WIDTH ft LENGTH <br />ft DEPTH <br />ft <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION <br />ft PROPERTY LINE <br />ft <br />❑ DISPOSAL PONDS <br />WIDTH ft LENGTH <br />ft DEPTH <br />ft <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION <br />ft PROPERTY LINE <br />ft <br />❑ SEEPAGE PITS <br />NUMBER WIDTH <br />ft DEPTH <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 REGULATIONS OF SAN JOAQUIN <br />COUNTY. <br />MINIMUM 48 HOUR ADVANCE NOTICE REQUIRED <br />FOR INSPECTIONS - PLEASE CALL 209 953-7697 <br />SIGNED <br />TITLE <br />DATE <br />DEPARTMENT USE ONLY <br />Application Accepte Date .9 ��yy7 �� Area V9I on Employe, <br />Final Inspection B Date 1,0 r �h 24010 SPECIAL PERMIT-ApprovRj� y ff <br />Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: ••�� <br />COMMENTS Conor j,;,4 f oic seyyer'� <br />PE <br />Code <br />Sc <br />INFO <br />Receive <br />By <br />Check#/ <br />Gash <br />Amount <br />Remitted <br />Date <br />Permit/ <br />Service Request # <br />Invoice # <br />Llaa� <br />o7s" <br />l5 <br />2•-72z <br />5p0D$ySH l <br />42-01 <br />bNV�k* <br />• ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />✓ J 111 <br />4/14/18 <br />