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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 EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS G I✓I( CITY/ZIP o2 31 U 3-0p _ CROSS STREET iEL FORA DO APN - - PARCEL SIZE e �y � d OWNER NAME XkyT I T si/V ,4 � PHONE --O'q -.3S S-.S/O OWNER ADDRESS _/7&6 In'WAewY 1?Agi -wA-�/ z//C-1 /W1(A�CITY/STATE/ZIP I—ATH2o Pr aA Q5 337 n . I i CONTRACTOR_ _G'I-{E3jll((7E V ('O A S U L l/AI l7 PHONE L-;20!7-.40 2 - /(a 52 CONTRACTOR ADDRESS �_ Q 0 ar 3 7,)4 CITY/STATE/ZIP 7Ek q 4.0a< CA 5 LICENSE 11CIC-42 111IC-36 OTHER VAF NUMBER_75*71 EXPIRATION DATE G13UL,'-0'-z-0 WATER TABLE DEPTH: ti 3D ft GEOGRAPHICAL INFORMATION: Coordinates X Y 64' PERC TEST # BUILDING PERMIT#C LAND USE APPLICATION# TYPE OF WORK: 11 NEW INSTALLATION C REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE 11 REPLACEMENT CI 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 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 LINIzS ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES 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 %11ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ SUMPS WIDTH ft LENGTH ft DEPTH �p �^ ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPE;at�llz nn ft ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH &/� J ftDISTANCE TO NEAREST WELL ft FOUNDATION ft PROPEl �0 ft ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH �� 9� ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE T 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. M1NBftJM 48 UR ADVANCE NOTICE REQUIRED FOR INSPECTIONS- PLEASE CALL (209)x953-7697 SIGNED TITLE C11//L �/Ul�/N�F/q DATE 7 /2-4,#`r -A EPARTMENTAJSE VNLY Application Accepted By_ Date _ Area ( Employee ID# Final Inspection By „� t �UJAA, Date (f/11 ❑ SPE IAL PERMIT-Approved by Character of Soii to Depth of 3 Ft: Pit/ um Soil Character: COMMENTS �e,r C, �Z L j 6n i n � PE SC Received heck# Amount Date Permit/ Invoice# Permit ID# Code INFO s Remitted Service Re nest# Z d s q SVZ 00 1 1 Q 3 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18