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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 / / F_XPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS z X Z/- 'j=- sC��4Iy(� 1�ti A CITY/ZIP GZ4 CROSS STREET hj�U!S AP tJ "Q��-O 2IJ PARCEL SIZE o . tv OWNER NAME W /Cr�� Si Ll}Gfp_ PHONE 074/- ri ti I J�ACn OWNER ADDRESS � CITY/STATE/ZIP CONTRACTOR 'e'-"/3e4 D�/�t/�J/ lJ/7C— PHONE 5(riy'SGZ� CONTRACTOR ADDRESS J7yL• .-1,,e_le v �f��` /�' CITY/STATE/ZIP LICENSE 004-42 ❑LIC-36 OTHER NUMBER, � S- U EXPIRATION DATE OBJ/3(U�Z/ l WATER TABLE DEPTH:eFb 1 496 ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: LI NEW INSTALLATION REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE 1.1 REPLACEMENT 17-1 OUT-OF-SERVICE SEPTIC SYSTEM IJ DESTRUCTION INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: SEPTIC TANK TYPE/MFG f-AI�vxt�41 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 U LEACHING CHAMBERS #OF LINES LENGTH OF LINES qO , ft DISTANCE TO NEAREST WELL i ft FOUNDATION /!fa i 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 SEEPAGE PITS NUMBER 3 WIDTH 'S ft DEPTH �S' ft DISTANCE TO NEAREST WELL iso ;A- ft FOUNDATION ft PROPERTY LINE- J40 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 (2091953-7697 SIGNED .-�L TITLE DATE — NT WV 'O'AQU Pki— NE — FD 19 N F Nn. — RIyNT • D E P A R-T M E N V USE ONLY Application Accepted Ry Date Area Employee ID#� Final Inspection By Date ❑ SPE AL PERMIT-Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS PE SC Received he Amount D to Permit/ Invoice# Permit ID# Code INFO B Cash Remitted Service Re Uest# 0 S RON l i -7 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18