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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205. (2019) 468.3420 <br />NON-REFUNDABLE PERMIT/ CALL X09 -7697FORIAtspEc770N5 EXPIRES I YEAR FROM DATE ISSUED <br />i-- Ar� �J"p <br />CITYIZA, O'r <br />CROSS STREET '�� �/- -�-' -f7-47 <br />OWNER NAME APNPARCEL SIZE ­ <br />OWNER ADDRESS PHONE ­­ - - — ­-- <br />CONTRACTOR I rue' <br />PHONE <br />CONTRACTOR ADDRESS TP AL <br />LICENSE f'l C-42 C-36 OTHERNUMBER I <br />WATER TABix DEPTH: J 7— <br />It GEOGRAPHICAL INFORMATION: Coordinates <br />FERC TEST <br />[:B�UI�LDING PEA�MIT# <br />- — ------- - LAND USE APPLICATION <br />TYPE OF WORK NEw INSTALLATION . .. ........... ......... <br />REPLACEMENT REPAIRIAD ENGINEER DESIGNEDIALTERNATVE <br />. . ....... . . . .. ....... . .... OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION <br />INSTALLATION WILL SERVE: <br />NUMBER OF LIVING UNITS'RESIDENCE COMMERCIAL OTHER <br />IA. I.. <br />NUMBER OF BEDROOMS: NUMBER OF F EMPLOYEES; <br />❑ SEPTICTANK TYPE/MFG CAPACITYg 1 <br />❑ GREASE TRAP TYPEIMFG a #OFP'jRTMENTS_ <br />tt <br />CAPACITY gal or <br />DISTANCE TO NEAREsT: WELL _ ft FOUNDATION <br />D LIFT STATION SIZEIt PR' INE ft <br />TYPE OF PUMP <br />(3 PKI; TX PLANT LI SAND OIL S <br />0 LEACH LINES LEACHING CHAMBERS_ #OFLINER — LENGTH OFLINES <br />DISTANCE TO NEAREST WELL It FOUNDATION .. ......... . it <br />0 FILTER BED WIDTH It LENGTH _it PROPERTY LINE, It <br />DEPTH It <br />DISTANCE TO NEAREST WELL..,,_" ft FOUNDATION ff PROPERTY LINE <br />0 MOUNDED W H ­__ It <br />1, ft LENGTH ft DEPTH__.__ ft <br />A14CE TO NEAREST WELL--- IT FOUNDATION <br />0 SU ._it <br />Mpg PROPERTY LINE _ ft <br />TO NEAREST <br />ft LENGTH DEPTH <br />u oftp WELL It FOUNOATK)N PROPERTY LINE--_ fI <br />...... ...... ....... . . . ..... LENGTH ft <br />DISTANCE To NEAREST WELL it F04JNDATION DEPTH . . ......... ............. . <br />L3 S AGE PITS NUMBER_ ......... . .... ­­--­ WIDTH PROPERTY LINE It <br />DISTANCE To NEAREST DEPTH It <br />WELL ft FOUNDATION PROPERTY LINE,,,_,._„ <br />I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH "k, <br />JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS, I ALSO CERTIFYTHAT MY REQUIRED LIC <br />WORKERS COMPENSATION LAWS. AT LICENSE IS <br />CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND TH I AM IN COMPLIANCE WITH ALL <br />SUMD <br />TITLE­..,Q��'!::!j­.. DATE <br />R M T S 0 0 y N <br />1jilk ' " — R T S <br />Application Accepted By <br />. ........ Area Employse ID# or, <br />Final Inspection 4; <br />-ter Of Soil to Depth Of 3 Ft: L.) <br />Character Oata._­­­.­­­-- SPECIAL PERMIT - Approveci by <br />COMMENTS PItfSumP Sail Character" <br />ft . . ... ....... 17 e ,4.ee <br />6/5117 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />tv <br />