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0 P <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 CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ^rI�SSUED <br />JOB ADDRESS %� �'^ I X G CITY/ZIP EsentinN <br />7 <br />CROSS STREET -`J r\12 T �i �i Z ADN Z Z i o✓'`� ` <br />C' /►PARR/CyELL SIZE n�%C •L.(I n <br />OWNER NAME EOUOR6�0 RU E�,J��RU5UO 'FPII JC �('✓)fCi;J �C6 PH/.J— v/�"1/ kg6(0 �s-3�%^`'5 <br />OWNER ADDRESS (/ 1 Y `[� A T � ftt O' RD CITY/STATE/ZIP /� J Ty C.��/ 4 L� •/"'+/ <br />CONTRACTOR 0 W KI [ R PHONE k /`'J r ) rf (3 f. /q^ .~JG L <br />CONTRACTOR ADDRESS , 1 �� r CITY/STATEIZIP 5 Tf H <br />LICENSE ❑ C-42 El C-36 OTHER NUMBER EXPIRATION <br />WATER TABLE DEPTH: -7t 6y ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br />❑ PERC TEST # I I BUILDING PERMIT # V i 7 &2 LAND USE APPLICATION # <br />TYPE OF WORK: NEW INSTALLATION REPAIRIADDITION 7jo q6 ( t ENGINEER DESIGNED /ALTERNATIVE <br />.. REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION <br />INSTALLATION WILL SERVE: Iy RESIDENCE ❑ COMMERCIAL ❑ OTHER <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: 4 NUMBER OF EMPLOYEES: <br />❑ SEPTIC TANK TYPE/MFG CAPACITY gal # OF COMPARTMENTS <br />❑ 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 />ly LEACH LINES <br />7 <br />LEACHING CHAMBERS <br />0 ft <br /># OF LINES LENGTH OF LINES <br />DISTANCE TO NEAREST <br />y'�3 <br />WELL � Q.I'L7)_ ft FOUNDATION i-S� ft PROPERTY LINE ft <br />❑ FILTER BED <br />WIDTH <br />ft LENGTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION fl PROPERTY LINE ft <br />❑ MOUNDED <br />WIDTH <br />ft LENGTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION fl PROPERTY LINE ft <br />❑ SUMPS <br />WIDTH <br />ft LENGTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION ft PROPERTY LINE ft <br />❑ DISPOSAL PONDS <br />WIDTH <br />ft LENGTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION fl PROPERTY LINE ft <br />❑ SEEPAGE PITS <br />NUMBER <br />WIDTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION ft PROPERTY LINE 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 />MINIMU <br />48 HO 6QVANCE N <br />TICE REQUIRED <br />FOR INSPECTIONS - CALL 209 953-7697 <br />SIGNED <br />lP�LEASE <br />ZL <br />TITLE 0 i. /46P- DATE .3'_I 8 ­ZZ- <br />Application Accepted a �— i/ Date S//a*ot Area tmployee lue 1 4 t/ <br />Final Inspection By Date % ,%�ZZ❑ SPECIAL PERMIT -Approved by <br />Character of Soil to 6e7pth of 3 Ft: Pit/Sump Soil Character: <br />COMMENTS Nr m rPCc,,f -f',er IT - Alle-; l bion J JnF bedloDal ji-,i lPr AP-000i7F-� <br />7` I ��' I ""` I gatel I Invoice # I Permit ID# <br />Code INFO B Cash Remitted 1 Service R es_t # <br />140101 01:5, Wk/1,1% lf3vb 'a0i Sl�cti� La <br />42-01 C W • Ho <br />4�� � • /L � /-� ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4114/18 � ) <br />