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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 �J EXPIRES 1 YEAR FROM DATE ISSUED J08 ADDRESS y 3 / C'�j I'll (l/� CITY/ZIP /(/( 1/ CROSS STREET APN D '� JV' PARCEL SIZE OWNER NAME / l/�j lJ&r'1 ��1`Jd PHONE J OWNER ADDRESS CITY/STATE/ZIP CONTRACTOR 11iyP R VL��(/kt)' 75:��-A' c PHONE '590 2661 CONTRACTOR ADDRESS C C e �Gi�/ Pl� /�Q /�- CITY/STATE/ZIP S%�Gsz��/r/^, cl�_ �j LICENSE dxC-42 [111C-36 OTHER NUMBER `� EXPIRATION DATE ^// WATER TABLE DEPTH: v ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE REPLACEME T OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: SEPTIC TANK TYPE/MFG 2 3 CAPACITY IC?00 gal #OF COMPARTMENTS_ ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS DISTANCE TO NEAREST: WELL 6C 0 ft FOUNDATION S ft PROPERTY LINE HCl ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) LEACH LINES I i LEACHING CHAMBERS #OF LINES /O_ LENGTH OF LINES f ft / DISTANCE TO NEAREST WELL ft FOUNDATION / ft PROPERTY LINE 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 .J SEEPAGE PITS NUMBER — WIDTH // ft DEPTH C'95 ft DISTANCE TO NEAREST WELL BOO ft FOUNDATION ft PROPERTY LINE s 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 ADV N NOTICE REQUIRED FOR INSPECTIONS- PLEASE CALL 2 953-7697 SIGNED TITLE Com//1 /( DATE loe 9 o � T ry D PA R TM EN TAJS EION Y Application Accepted By Date Area Employee ID# Final Inspection By Date M114 ❑ SPEC AL PE MIT-Approved by Character of Soil to De h of 3 Ft: Pi Summp/Soil Character: COMMENTS��T� 11AZ1�`.�2!' //I, � CLQ!! ✓'��1�/V�� �' ✓ PE SC Received eck Amount Permit/ Code INFO B s emitted Date Service Reguest# Invoice# Permit ID# 0 2,3by l°I 0 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18