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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT • SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468.3420 NON-REFUNDABLE PERMIT rr CALL 09 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS V V v V CITY/ZIP CROSS STREET L !'J,�/ APN PARCEL SIZE 3. 5'yFjt OWNER NAME / /'{ HCl(' ��-CPHONE OWNER ADDRESS ^ p�,1� CITY/STATE/ZIP A CONTRACTOR 1/ d e eP •Y JC LO FI- PHONE S� ��^SCJ I TCS I �-- CONTRACTOR ADDRESS 7d T ��/'rV�r CITY/STATE/ZIP �O� C�f7� LICENSE El !C-42 ❑-'C-36 OTHER 14 NUMBER?K 3 EXPIRATION DATE z�z 2Vz 1/5 WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: p NEW INSTALLATION REPAIR/ADDITION I_ ENGINEER DESIGNED/ALTERNATE REPLACEMENT OUT-0 C OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION T 7 Cs UA INSTALLATION WILL SERVE: 9 RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: / NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: 41 SEPTIC TANK TYPE/MFG L— CAPACITY gal #OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS DISTANCE TO NEAREST: WELL 4.22' ft FOUNDATION �1^') , ft PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) ❑ LEACH LINES a LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft AY� DISTANCE TO NEAR E�T WELL ft FOUNDATION ft PROPERTY LINE �/1F'��• FILTER BED WIDTH ft LENGTH wft DEPTH ft yC DISTANCE TO NEAREST -WELL It FOUNDATION ft PROPERTY LINE B ❑ MOUNDED WIDTH it LENGTH ft DEPTH 19 2019 DISTANCE TO NEAREST WELLft FOUNDATION It PROPERTY LINE� AQ ft /1 Ll SUMPS WIDTH ft LENGTH ft DEPTH UI DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE, RONM;EN7'AL ' ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH DEPAR rA4SN7- 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 1 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. MINIMUMQIH011R ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 SIGNED , TITLE Aj DATE Z PARTMENT USE O LY Application Accepted By VL Date 20 i q Area C Employee ID# VI Final Inspection By Date ; ZO l ❑ SPECIAL PERMIT-Approved by Character of Soil to D pth of 3 Ft: Pit/Sump Soil Character: COMMENTS QARftr.s-e✓ ala✓ VIIIGC Ii,l�4,- cO• JCL Pti'ab PESC Received hec Amount Date Permit/ Invoice# Permit ID# Code INFO B ash Remitted Seri # ro y 3�c 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14118