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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 CALL 209 953-7697 FOR INSPECTIONS EXPIRES/I YEAR FROM DATE ISSUED JOB ADDRESS `7O�I c�OLt�IQj goC/Gr' CITY/ZIP CROSS STREET . G PICT I ''nn1��o/,aI V' APN� Z- 3010 �J� PARCEL SIZE C OWNER NAME �U Q U'I (f I V I� PHONE z OWNER ADDRESS CITY/STATE/ZIP 11- CONTRACTOR PHONE 0 2�q "LlCONTRACTOR1A/DDRESS �r c �� h Pe's LLAI_ CITY/STATE/ZIP 6 � `^�, Y/ 1 �L/ LICENSE ❑INC-42 ❑I IC-36 OTHER NUMBERyy EXPIRATION DATE `I- 3 r- l�/ WATER TABLE DEPTH: ( �/ ft GEOGRAPHICAL INFORMATION: Coordinates X Y C PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: I I NEW INSTALLATION REPAIR/ADDITION 1 ENGINEER DESIGNED/ALTERNATIVE I I REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: RESIDENCE G COMMERCIAL C OTHER NUMBER OF LIVING UNITS: NUM/BER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPE/MFG F_Y 16�i VI!� I CSO 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) ------------------- ------ x / LEACH LINES LEACHING CHAMBERS #OF LINES / LENGTH OF LINES 140 ft i DISTANCE TO NEAREST WELLJ_ ft FOUNDATION d ft PROPERTY LINE SO ft ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft SEEPAGE PITS NUMBER 0- WIDTH 13 3 ft DEPTH r9 S / ft DISTANCE TO NEAREST WELL_L/ (O ft FOUNDATION 70 ft PROPERTY LINE SO 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. MINIMUM 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 9//5,,3-7697 1�y SIGNED �p TITLE W �lll DATE 6 —c> J R C A A F T ` EPARTMENT V SE N 1, Y Application Accepted By Date Ar a Employee ID# _ji*k-- Final Inspection By Date SPECT L PERMIT-Approved by Character of Soil to Depth of 3 Ft: Pi/Su p Soil Character: /� COMMENTS ��f/V�E'�i /{�f �l� D�S� ��/�l�f&I& L SV PE SC Received eck#/ Amount Date Permit/ Invoice# Permit ID# Code INFO B Remitteo Service Request# 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18