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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-REFUNDABLEPERMITCALL 209 953-7697 FOR INSPECTIONS EXPIRE S 1 YEAR FROM DATE ISSUED JOBADDRESS CITY/ZIP I;Sc0Ion CROSS STREET U APN O 7 If /0 Z PARCEL SIZE7 V C Of OWNER NAME 3�+Xt/Q V/ J n O / ,��/� C PHONEr Z O r,- CONTRACTOR -� OWNERADDRESS Z /3, p��t,J]1L l �� LLl�YlQ/ ! 5? CITY/STATE/ZIP G L Sr pJ6111 /l - CONTRACTOR JOh S `✓-`&'"}Oe, S,P.IV"CP PHONE �J Y -2 'T-( / �1 7 (� CONTRACTOR ADDRESS � � �L� C IL 1 I1 D CITY/STATE/ZIP L4 1 cz L, ( q q 3,:P- / 5 LICENSE ❑i C-42 ❑I_C-36 OTHER NUMBER I 7S3 EXPIRATION DATE WATER TABLE DEPTH:q0 l OO ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT# BP -Ieo67),q LAND USE APPLICATION# TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIV A REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL �J ❑ OTHER NUMBER OF LIVING UNITS: L NUMBER OF BEDROOMS: y �q ny\ NUMBER OF EMPLOYEES: M SEPTIC TANK TYPE/MFG I �^ C O n G J�4"J CAPACITY 1 6Vgal #OF COMPARTMENTS Z ❑ 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) ❑ LEACH LINES A LEACHING CHAMBERS r Infli I Trp, kul- 36 #OF LINES Z LENGTH OF LINES Ll il ��" �` ft DISTANCE TO NEAREST WELL 1,5'0 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 I ' ftr FOUNDATION ft PROPERTY LIINE ft SEEPAGE PITS NUMBER Z WIDTH / 4 c - r ft DEPTH Z� I ft DISTANCE TO NEAREST WELL 7� ft FOUNDATION d 0�- ft PROPERTY LINE Z 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 RE IRED FOR INSPECTIONS- PLEASE CALL 2 9 -7697 SIGNED TITLE U finer DATE R P T EPARTMENLLISEdN.LY Application Accepted By A Date Area "f Employee ID# Final Inspection By Date f< ❑ SPECIAL PERMIT-Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS PE SC Re eived Check#/ Amount Date Permit/ Invoice# Permit ID# Code INFO B Cash Remitted Service Request# va LAI, l l 10� 42-01 �w q�. 9'3 goo ("o ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18