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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT 'SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)465-3420 NON-REFUNDABLE UPERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS yy 1 H�L�CZETh _;ti CITY/ZIP �5 1P �/1,1G9�J Z Z(Z �� y CROSS STREET 'Illy 9MBrzw Al:r APN, 1/1� w v L / _ PARCEL SIZE OWNER NAME_ VFFMJ I?CC��Z PHONE OWNER ADDRESS _ ,54-mer CITY/STATE/ZIP / i l - - CONTRACTORJ� COn/$TRt tc7SDn7 3 Sc"Prr`� T/Uz, PHONE IC//tg/ 2-- Z'T- 4{1 $-7 CONTRACTOR ADDRESS J�5`77 °CIS -5642'G 7CdG CITY/STATE/ZIP S.�Lt2�F/Y /I/Ya��+} aS LICENSE l'42 -1 C-36 OTHER NUMBER %22y3& EXPIRATION DATE 0.?-C;' WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X__ Y f PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE 7� REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION (py/p '�G/C�J/•V�t}/L INSTALLATION WILL SERVE: L RESIDENCE COMMERCIAL OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: 3 H609�UMBER OF 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) LEACH LINES ✓ LEACHING CHAMBERS-:7-1Vr:rj,?f2.Tra(Z _ #OF LINES _.,Z _ LENGTH OF LINES DISTANCE TO NEAREST WELL /00 / ft FOUNDATION -2`� 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 FOUNDATIIOON ft PROPERTY LINE ft UI SEEPAGE PITS NUMBER �� WIDTH 7 ft DEPTH 7r-1 ft DISTANCE TO NEAREST WELL /Sa ft FOUNDATION Z✓ ft PROPERTY LINE 20' ft 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. PLEAK"LL (2021 SIGNED TITLE DATE U ell 2 O H "VIFO N R M D PA R T M E N T IJISE UNLY Application Accepted BDate ( Area Employee ID#� Final Inspection By �� Date SP IAL PERMIT-Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: / _ COMMENTS Z� (JAL9 71U&M A/0ljzi,(iS 10affZ� 6., 21X1 D� i1W PE Sc Received Check#/ Amount PermiU ,L. Code INFO B Cash Remitted Date Service Request# Invoice# Permit I D# C 'b 42-01 t q T_/ , 3 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18