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N ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 NON-REFUNDABLE PERMIT TYPE/MFG GALL ZUY -/6y/ FOR INSPECTIONS LXPIRES I YEAR FROOMM UAIE ISSUEI JOB ADDRESS ❑ GREASE TRAP �Ybj /G CITY/ZIP 7 CROSS STREET %0�/l��✓/�/1//i� Gl APN 013jO PARCEL SIZE S• o�j//� OWNERNAME Ar'd V�_� �("� ft PHOON/E f-0-1 O' ❑ PKG TX PLANT CITY/STATE/ZIP V4,n C� (J / id"'o OWNER ADDRESS I ' ` f )/1 / CONTRACTORle PHONE 776! -a �-IlbS l N CONTRACTOR ADDRESS d ft CITY/STATE/ZIP JJ lfz1 /Q e!q LICENSE W --C-42 ❑ C-36 OTHER NUMBER CI EXPIRATION DATE WIDTH ft LENGTH WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION ❑ PERC TEST # BUILDING PERMIT # TYPE OF WORK: NEW INSTALLATION EPAIRIAD! Coordinates X Y LAND USE APPLICATION #_ IN ENGINEER DESH REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION NED /ALTERNATIVE INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: 7 ❑ SEPTIC TANK TYPE/MFG CAPACITY gal # OF COMPARTMENTS Amount Dat Remitted ❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS )IY DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) ! BEACH LINES LEACHING CHAMBERS .l'� # OF LINESIgor— LENGTH OF LINES 7 ft , Vim` J DISTANCE TO NEAREST WELL � j ft FOUNDATION 7 X ft PROPERTY LINE 5 ft ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PR PERTY LINE ft SUMPS WIDTH ft LENGTH L� i ft DEPTH�I ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. MINLAOJM48HO AD ANCE NOTICE REQUIRED FOR INSPECTIONS -PLEASE CALL 209 953-7697 SIGNED TITLE C�� U DATE'VZ DEPARTMENT.USiF ONLY el Application Accepted By L�� - Date d 6 �•l f1 aZ Area 1 Employee ID# J Final Inspection By (r&.,\ u'S ((,N C4e,,naa. AA&41_ Date 2� �2� ❑ SPECIAL PERMIT -Approved by Character of Soil to Depth of 3 Ft: -Pit/Sump Soil Character: COMMENTS IIB ►door/6r�c�ce w�7S v<eCl/ jp p��sf 'Gr 0 fml� flow, JS`, CR T PE Code Sc INFO Received B -,Gff6cW �h Amount Dat Remitted Permitl Servic Request # Invoice # Permit ID# a)L► )IY �3 +300 S s- 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18