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n , ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTOIi CA 95205-(209)468-3420 NON-REFUNDABLE PERMIT CAL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR -F-R D SUED JOB ADDRESS �,. CTTY/ZI P7 CROSS STREET u7v�'. APN �/� (/—I [ PARCEL SIZE 4 y OWNER NAME C •� PHONE D'L/C,- lr7L �OCiI z y OWNER ADDRESS CTrY/$TATE2IP CONTRACTOR ! PHONE -Ja 7 7 � �`� CONTRACTOR ADDRESS LP1 I Y O/ SG1�1 /SIJ' CITY/STATE/MP LICENSE -42 G36 OTHER NUMBER EXPIRATION DATE WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y PERC TEST X BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE; RESIDENCE COMMERCIAL OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ SEPTICTANK TYPEIMFG L'V/ �/"/ot; CAPACITY gal #OFCOMPARTMENTS ❑ GREASETRAP TYPE/MFG CAPACITY gal #OFCOMPARTMENTS DISTANCE TO NEAREST: WELL R FOUNDATION ft PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP _ ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) LEACH LINES LEACHING CHAMBERS i #OF LINES T LENGTH OF LINES 5S , ft DISTANCE TO NEAREST WELL [/ ft FOUNDATION [C/ It PROPERTY LINE 30 ' ft A LIFILTER BED WIDTH It LENGTH It DEPTH ft A DISTANCE To NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ MOUNDED WIDTH ft LENGTH it DEPTH ft - DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft SUMPS WIDTH L� It LENGTH /c� ' ft DEPTH fG ft DISTANCE TO NEAREST WELL rr'C' ft FOUNDATION &G'/ ft PROPERTY LINE frl�-J / 1 ❑ DISPOSAL PONDS WIDTH It LENGTH ft DEPTH ft JOp!AQ A' `O� DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE /�TQ O/'r CO T ❑ SEEPAGE PITS NUMBER WwH ft DEPTH ft IJ Ty OFpq FART !' DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft RTMENT 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. A41NM4UM 48 H N12TICE REQUIRED FOR INSPECT100-"LASE CALL(209)95 3-769 SIGNED _ _ _ TITLE__ � C �--_. _. DATE '- IL D T E NL Application Accepted By a Area Employee ID#� Final Inspection By Date O, { h, SPEC PER IT-Approved by Character of Soil to Pepth of _ 13 Ft: P"ump Soll Character:_ COMMENTS 1 Ol PESC Recelved Ch Amount Dam Permit/ In Ice X Permit IDX Code INFO Remitted Service R Vest t O Z LCD< 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18