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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 <br />LU9 V03469/ FOR INSPECTIONS <br />I=XPIRES 9 YEAR FROM DATE ISSUE <br />JOBADDRESS <br />Q <br />n' .t:ALL <br />T WA�Yw uV II CITY/ZIP 41-I0RN%D/1 <br />1/ 06 <br />CROSS STREET 7-1-1o)wro,u <br />❑ FILTER BED <br />R 0A P <br />APN 1901-140-40 <br />PARCELSIZE �•QTI�QpRQG <br />OWNER NAME <br />SI 14 <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />PHONE 15't ' 4/4� 1 � l <br />OWNER ADDRESS <br />nDI <br />) <br />✓1 ��t"(�12 <br />�CFt �` ? <br />C� t'/' <br />/� `' <br />N Y CITY/STATE/ZIP <br />lT1Jr'I <br />CONTRACTOR <br />`` // <br />N <br />C <br />PHONE oZO 9 <br />- 4,9 2 16 S Z <br />CONTRACTOR ADDRESS F. 0 • <br />Q x t- <br />-41"j <br />CITY/STATE/ZIP <br />^'' <br />r/kA CJ5C CLQ <br />LICENSE []-.C-42[1-C-36 <br />p <br />OTHER ILG� <br />CSL <br />NUMBER 7�I J EXPIRATION DATE <br />tY-30'.a2 <br />D <br />WATER TABLE DEPTH: oc ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br />PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # <br />TYPE OF WORK: - NEW INSTALLATION _ REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE <br />REPLACEMENT _ OUT -OF -SERVICE SEPTIC SYSTEM _ DESTRUCTION <br />INSTALL ATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br />O SEPTIC TANK TYPE/MFG CAPACITY gal # OF COMPARTMENTS <br />O GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS <br />DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br />❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />O LEACH LINES <br />F LEACHING CHAMBERS <br /># OF LINES <br />LENGTH OF LINES ft <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ FILTER BED <br />WIDTH ft LENGTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />O MOUNDED <br />WIDTH ft LENGTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ SUMPS <br />WIDTH ft LENGTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ DISPOSAL PONDS WIDTH ft LENGTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />O SEEPAGE PITS <br />NUMBER WIDTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />I HEREBY CERTI THAT I HAVE THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br />7EPARED <br />STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN <br />COUNTY. <br />MINI UM 48 <br />NOURWMANCE NOTICE REQUIRED <br />FOR INSPECTIONS - PLEASE CALL (209) 953-7697 <br />SIGNED <V,t-/N T/Aff.f/.Y TITLE CI0V iW41NEEIZ DATE 3/3l /A <br />32022 <br />E �1UNrY <br />Ddil ARTMEN , U E ON , Y/ <br />Application Accepted By to - v Area Employee ID#� <br />Final Inspection By Date // . ❑ SPECT L PERMIT -Approved by <br />Character of Soil to Depth of 3 Ft: PIS tlSump S Character: <br />COMMENTS <br />PE SC Received Chec Amount Date <br />INFO ash Remitte <br />Permltl Invoice # Permit IIICode <br />Service Request # <br />22 0 3225 <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4/14/18 <br />