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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1858 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)458.3420 <br /> NON-REFUNDABLE PERMIT CALL 8).953-7597 FOR INSPECTIONS.__._ EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS <br /> �'-"____._._.-..._...._ t`.7 �. I���. ��. ,CRY/LIP.....r?C.E...S.�•...{-.E' .A..�...�Z"_� <br /> CROs$STREET ....../ S O .____..._.......APN_ UC`�_...- y� O 2' _PARCEi.512E.. ;fir",L_,__.. r <br /> OYrNEA NAYSt^t f3 S+ctXi�a__yi f-IA Ga.ys Tr�e.,sc.-r�-IIJ _..... PHONEtt+'i�-+-iS`t 3 <br /> '2 0 7-&'�• rJ I t�y. ._. CRY/STATE/ZtP it'h.P rJ L.-Pt �5�--3-a ' <br /> OWNER ADDRESS � _._....._...._._...._........_.�._-._. <br /> CONTRACTOR E- D PD K• GL U y IJV t(zO e�3 M r--TA A L..__.PHONE <br /> 40 <br /> CONTRACTOR ADDRESS _( .CMR t y <br /> 4�0"I (N• t7J�C1� I _CRY/STATEIZP _ ...._._ _ <br /> trcENEE U C�42 ''=,= C •4T 7.-F� I EXPIRATION DATE_! ` <br /> ._�C-35 O'rxeR_�,..-.,�n—_._ NuYEgra�..._,. _..__ <br /> WATER TABLE DEPTHc ..__..._ ft GEOWIAPHICAL INFORMATION: Coordinate$ X....__—____..._..___._.._-. �..— ............. <br /> ___ _ <br /> I j PI 7E5T ) l 6Ul 146 PERMIT# LAND USE APPLICATION 8 - <br /> _. -- <br /> TYPE OF WOi2K: NEW INSTALLATWN REPAWIAociT10N �.. F_NOtNEEA DSStGNED/ALTERNArnE <br /> REPLACEMENT OUT-OF-SERVtCESEFhc SYSTEM DESTRUCTION,_ _ _.�...._ <br /> _ ...... _... — <br /> 1N5TALLAT10N WILL SERVE: r R€S+DENcECOMuERCIAl <br /> OF BEL7THER_.__ — <br /> NtiAlifER OF EMPLOYEES:_W, <br /> �NUYB£R OF L1VUXi LIwTB: NUMBER DRQOMS._- -„_.._ ......._._.._._--....._.._._....._...-._...__.... .. ___._W� ; <br /> ❑ SEPTIC TANK TYPEJtAFG ;APACITY— .. rat #of COMPARTMENrB__ - <br /> ❑ GREASE TRAP TYP-JMFG—.__..,._ — CA-PACtTY _. gaf 1f of COMPARTMEWS _— <br /> DISTANCE TQ NEAREST: WELL — It FOUNDATION,_.—..._._....— ft PROPERTY LINE N <br /> ❑ LIFT STATION S¢E .....................____.__.TYPE OF PUMP...._....,..—_.❑ PKG TX PLANT U SAND OIL SEPARATOR(ENCLOSED SYSTEW <br /> 0 LEACH LINES LEACHING CHAMBERS­---.­­-­--- � Ut+Es LENGTH OF LINES.. —It <br /> MSTANC£TO NEAREST VVTvl.t. ft FOONDATKNS:...,.__....__..—_-._...R PROPERTY LINE ...R , <br /> ❑ FILTER BED WIDTH _ ft LENGTH_,___,_„y-_______­_.__—ft DEPTH -If <br /> DISTANCE To NEAREST WEtI It FOUNDATION„_._.._ .__-.-n PROPERTY LINE It <br /> ❑ MOUNDED WIDTH R LENGTH _. fi DEPrr+_. ...... ft <br /> DIS TANCE TO NEAREST WELL---kt�FOUNOATtON_,_. ----ft PROPERTY <br /> ❑ SUMPS WIDTH _____ft LENGTH ft DEPTH__'_..-.__,._...-- _.._ft <br /> DISTANCE TO NEAREST WELL tf FOUNDA7';ON__,,.,_�_ ft PROPERTY LINE.._.-._.. ft <br /> ❑ DISPOSAL PONDS WIDTH__ A LENGTH _ —h DEPTH_.._....._ .__ _. ft <br /> DISTANCE TO NEAREST WELL .....ft FOUNDATKkt ____ ft PROPERTY LINE-_—,It <br /> U SEEPAGE PITS NuueWVSYH n fJEPTYI _ R <br /> £R <br /> DISTANCE To NEAREST _._VAEtL t1-..-FOUNOl`TI�1 � ft PROPERTY -- ft <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORX WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS Or SAN JOAQUIN COUNTY. <br /> rWE REQUiREZ).FOR I _ <br /> IZW <br /> . /.._�`.___... .____..........._ _... �O rlll • -_ ._... <br /> SIGNED�._..__. TITLE .t..(�.-.._ .�,...-._......_. DATE _ <br /> - i PAYMENT <br /> i - RECENEO <br /> SEP 2 2 2022 <br /> 1 � f <br /> _' .}.... SAN JOAQUIN COUN <br /> ENVIRONMENTAL <br /> - ? 1 <br /> ;p E P A R T M�___L... u i <br /> � ;'z✓zi AreA „_,1 ,�_- FmptoyeekDal_ ,,^-____._._ <br /> Application Accepted By ___-_-- Date._.. .+�� ,t�___.�___ <br /> Character of ion By Depth of 3 Ft Date _._.._•...._........__.__ <br /> _. <br /> Fmat Inspection Y-- ---' _. .�_ 0 SPECIAL PERMIT-Appmed try <br /> Pit/Sump Soil Character: .._.._—._------- — -_ <br /> COMMENTS --~ <br /> — Invoice i Permit tDt <br /> PE SC Received Check f! Amount <br /> Coda-, INFO By_ C h Remitted <br /> ONS'TE WASTEWATER TRlMNT SYSTEM PLRYIT <br /> 42 01 <br /> 4174/18 <br />