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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT • z SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 95202-(209)468-3420 NON-REFUNDABLE PERMIT ppCALL 209 953-7697 FOR INSPECTIONS EXPIRE°S�'I YEAR FROM DATE ISSUED JOB ADDRESS I I 0(p I�"T� _CITY/ZIP M I��`/^-` q E-33(e CROSS STREET ( D�(�L APN 2-24— 03o- X(p PARCEL SIZE (o Ac - o Ti' l OWNER NAME `�C 1"1—� "} •"T m n� ` PHONE 2Z0�} �OSEYN ITS- PCiIE. CITY/STATE/ZIP MA-�C,A- cA 1K33&9OWNER ADDRESS 'A,' _ CONTRACTOR— t-)VE 0� 6Eo ENV I j2-otjmC�l AL- PHONE 3 k 9-1b�3}^Sp cis-1-10 CONTRACTOR ADDRESS 14c--i w. O� �', . CITY/STATE/ZIP L-�V( Nl -`s-1`•0 LICENSE _;C-42 -;C-36 OTHER NUMBER EXPIRATION DATE WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT DESTRUCTION INSTALLATION WILL SERVE: RESIDENCE COMMERCIAL:::�::�NUMBER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: 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 ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) w ❑ LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES / ■�� DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE E ❑ FILTER BED WIDTH ft LENGTH ft DEPTH �VNT P® DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINER ❑ MOUNDED WIDTH it LENGTH ft DEPTH y 4 2019 DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE� �Iy ft ❑ SUMPS WIDTH ft LENGTH ft DEPTH ,,''� ry�0 NC DISTANCE To NEAREST WELL ft FOUNDATION ft PROPERTY LINE ENTq IVT)• ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH �~l1LL ``**''�"CCCC L DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft RTiy/ENT ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It 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. AININ7,, UR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 SIGNED TITLE c owst uT�N T DATE - I C1 ID pr} 2 3 rn co iii. DEPARTMEN JSE NLY � Application Accepted By Date Area /3 1 Employee ID# Final Inspection By Date i] SPECIAL PERMIT-Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS 1�P�� `�/' S� 7-C' PE SC Received Chec Amount Date Permit/ Invoice# Permit ID# Code INFO B s Remitted Service Request# LZ Z— 1 5 (L 110 l 42-�� ONSITE WASTEWATER TRTMNT SYSTEM PERMIT