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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET - STOCKTON CA 95202 - (209) 466-3420 IVON-KEFUNDABLEtVERRMIITT A`LL LUV)'d0-J-/by/ FOR INSPECTIONS 'II YEAR F�RLO,M UATE ISSUEI JOB ADDRESS r 23 '( -f J Q /�L s �+ j Ir- V P—✓ • p �tX`P,IRES CITY/1ZIP T1�FC�'1 / J .30 + • CROSS STREET L0JEL.y APN - I 0 0`1 PARCEL SIIZ�E- I' S FTC ''i OWNER NAME � P F -N p, ��VV f \ �� PHONE s-( O _ + 'I - (030 O OWNER ADDRESS /-F O. 30^ 335- CITY/STATEIZIP CA 90443 CONTRACTOR ,P. 1-1Qf-tt��vkK- G -E -o En)V12afJ✓►��rHL- GPffrTE�S-aZ� PHONE -1 -3V 1-o -4-S CONTRACTOR ADDRESS 40-+ W - L)Pam ST. CITY/STATE/ZIP LLD L � CA 9579-40 LICENSE C-42 C-36 NUMBER EXPIRATION WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ LEACH LINES PERC TEST# I I BUILDING PERMIT # # OF LINES LENGTH OF LINES ft LAND USE APPLICATION # TYPE OF WORK: Ii NEW INSTALLATION I I REPAIR/ADDITION L ENGINEER DESIGNED /ALTERNATIVE WIDTH ft LENGTH REPLACEMENT II DESTRUCTION INSTALLATION WILL SERVE: I RESIDENCE I I COMMERCIAL I OTHER WIDTH ft LENGTH NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPE/MFG CAPACITY gal # OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS ❑ DISPOSAL PONDS WIDTH ft LENGTH DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) ❑ LEACH LINES l LEACHING CHAMBERS # OF LINES LENGTH OF LINES ft DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft ❑ FILTER BED WIDTH ft LENGTH It DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ MOUNDED WIDTH ft LENGTH it DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL It FOUNDATION It 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 It 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. MINIMU OUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 SIGNED /`ci l p TITLE GO^S01�-r DATE I ' TiS -G Application Accepted By Final Inspection By� Character of Soil to Depth of 3 COMMENTS ARTMEN USE ONL ,Pate Area Date ! f I SPEC L PE MIT Pit/Sump Soil Character: NT 2018 NTAL Employee ID#� Approved by 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT