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i ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 95202-(209)468-3420 NON-REFUNDABLE PERMIT CALL 209 953-77697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS IOZ0c) 4 113SV `• ,LEV" —F" CITY/ZIP CS C4yt"I_ 16 IS-3 ;?-0 y .�,Q' j� vya CROSS STREET ( 'W-/ �' APN �^ r ..3 Q PARCEL SIZE /f •S- '' - rj � .t 7Op OWNERNAME hj0(zy'A//��,,j 6t—NEE NOWTy pPHONEE �6,`U \4�T�-&q4� rMn OWNER ADDRESS P-o, Fo /07-4 CITY/STATE/ZIP W F-1&II I wmu, cA g23q-4- -CONTRACTOR LIVE 0&1=- CSEoEpN�V✓I i'►'1 E1�-�a�� PHONE 3k1C7'013"1 CONTRACTOR ADDRESS U w" �Y`�' �' CITY/STATE/ZIP LICENSE . ,C-42 QC-36 OTHER NUMBER EXPIRATION DATE WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# - 1114 TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT I I DESTRUCTION INSTALLATION WILL SERVE: RESIDENCE COMMERCIAL J OTHER 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 DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ff ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) ❑ LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ FILTER BED WIDTH ft LENGTH It DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE ft ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft ❑ SUMPS WIDTH ft LENGTH It DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ DISPOSAL PONDS WIDTH ft LENGTH It DEPTH ft DISTANCE To NEAREST WELL It 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. MINI 4 UR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 SIGNED /�ry — TITLE C.6►JSVi.-T�tNT DATE g'2^ 11 MENT g # CEIVED t G 06 2018 j PARCEL PARCEL 1 j AQUIN COUNTY £ RONMENTAL DEPARTMENT � I PARCEL n� PARCOw tl yZj I R ; - -----a-------- --- .T A� Application Accepted �By) n` /► Date Area Employee ID# Final Inspection By /Vus�2ty^W n n�2i Date/V�L�1 L LY ❑ SPECIA IT-Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS PE SC Received Check#/ Amount Date Permit/ Invoice# Permit ID# Code INFO By Cash Remitted Service Reqlliest# 4 225Z. ( 6-C-) 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT