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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE-STOCKTON CA 95205 - (209) 4653420 <br />NON-REFUNDABLE PERMIT 2 -� ( CALL 209 953-7697 FOR1NsPECTIoNs /,EXPIRES 1 YEAR FROM DATE ISSUE[ <br />JOB ADDRESS 27114 -Q - ik`i EP— L� - CITY/ZIP__ STZ)CJ --a� f �Z, II�G <br />CROSS STREET W �E-,``� APN (� 1 - �7Z PARCEL SIZE 1-P - i <br />OWNER NAME E-Er—NfRr.JDo Cee-yi SES PHONE IO(¢2- 2-141 <br />OWNERADDRESS C/O ONA�GO PArrt-ECO / rl S.�O NO(aME1-n1 CR/�r <br />Y/STATEIZIP _�_/_ Ck-TTJN CIff <br />CONTRACTOR r -f ✓4� O�1L G �O�NVI(ZONWI E7LJ 1 ft'L PHONE 3(P 11 -03-7 -- <br />CONTRACTOR ADDRESS 40-7 W -CITY/STATE/ZIP"-b I C19 9 �Z�a <br />LICENSE [1(.-.Z-42 OoC36 OTHER CELT NUMBER '2-15- I EXPIRATION DATE 4 -3 0 - 2-1- <br />WATER <br />Z <br />WATER TABLE DEPTH: <br />ft GEOGRAPHICAL INFORMATION: Coordinates X <br />Y <br />PERC TEST # <br />II BUILDING PERMIT # <br />LAND USE APPLICATION # <br />TYPE OF WORK: <br />NEW INSTALLATION C <br />REPAIR/ADDrnON <br />C ENGINEER DESIGNED/ALTERNATIVE <br />WELL <br />Cl REPLACEMENT El <br />OUT -OF -SERVICE SEPTIC SYSTEM <br />[) DESTRUCTION <br />INSTALLATION WILL SERVE: ❑ RESIDENCE <br />❑ COMMERCIAL <br />❑ OTHER <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: <br />NUMBER OF EMPLOYEES: <br />❑ SEPTIC TANK <br />TYPEMIFG <br />CAPACITY <br />gal # OF COMPARTMENTS <br />❑ GREASETRAP <br />TYPEfMFG <br />CAPACITY <br />gal # OF COMPARTMENTS <br />ft FOUNDATION <br />DISTANCE TO NEAREST: WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ LIFT STATION <br />SIZE TYPE OF PUMP <br />❑ PKG TX PLANT ❑ <br />SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />❑ LEACH LINES ❑ LEACHING CHAMBERS <br /># OF LINES <br />ON <br />LENGTH OF LINES ft <br />ft PROPERTY LINE ft <br />ft DEPTH ft <br />ft PROPERTY LINE ft <br />It DEPTH ft <br />ft PROPERTY LINE ft <br />ft DEPTH ft <br />ft PROPERTY LINE ft <br />ft DEPTH ft <br />ft PROPERTY LINE It <br />_ft DEPTH ft <br />ft PROPERTY LINE ft <br />1 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 />Final Inspection By Date ❑ SPECIAL PERMIT -Approved by <br />Character of Sail to Depth of 3 Ft: Pit/Sump Soil Character: <br />COMMENTS <br />PE <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATI <br />FILTER BED <br />WIDTH <br />It LENGTH <br />Date Invoice# PermitlD# <br />Remitted Service R uest# <br />aa -1 <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />MOUNDED <br />WIDTH <br />ft LENGTH <br />I � <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />SUMPS <br />WIDTH <br />ft LENGTH <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />DISPOSALPONDS <br />WIDTH <br />ft LENGTH <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />SEEPAGE PITS <br />NUMBER <br />WIDTH <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ON <br />LENGTH OF LINES ft <br />ft PROPERTY LINE ft <br />ft DEPTH ft <br />ft PROPERTY LINE ft <br />It DEPTH ft <br />ft PROPERTY LINE ft <br />ft DEPTH ft <br />ft PROPERTY LINE ft <br />ft DEPTH ft <br />ft PROPERTY LINE It <br />_ft DEPTH ft <br />ft PROPERTY LINE ft <br />1 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 />Final Inspection By Date ❑ SPECIAL PERMIT -Approved by <br />Character of Sail to Depth of 3 Ft: Pit/Sump Soil Character: <br />COMMENTS <br />PE <br />Sc Received <br />Chec / <br />Amount Permit/ <br />Code <br />INFO B <br />ash <br />Date Invoice# PermitlD# <br />Remitted Service R uest# <br />aa -1 <br />Sa3 <br />I � <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4/14/18 <br />