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r 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 2.x'13 7� �(I(IL 4CVVL M CITY/ZIP k—c"M,n Q /� r�-y CROSS STREET-�(r��w� C4- APN 0 �!� U V PARCEL SIZE GS,' V M OWNER NAME ��LIL rr.� � I 1 r Y� 5 e "I J T r• PHONE 2- OWNER ADDRESSh_ 'r/r' of n _ _ CITY/STATE/ZIP e /\ q � C CONTRACTOR T5 �`�S� t�G�-�� -D PHONE Lel Ll 1 Il�l SJ �7 CONTRACTOR ADDRESS O J 7 ni�.5cy\ CITY/STATE/ZIP LICENSE 1KC-42 CLIC-36 OTHER NUMBER IZZ1,(3/b EXPIRATION DATE 07/2V2, WATER TABLE DEPTH: y I S v ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: ❑ NEW INSTALLATION REPAIR/ADDITION U ENGINEER DESIGNED/ALTERNATIVE El REPLACEMENT CJ OUT-OF-SERVICE SEPTIC SYSTEM ❑ DESTRUCTION INSTALLATION WILL SERVE: lg RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: I 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) Or LEACH LINES ff'J—LEACHING CHAMBERS Z #OF LINES 2 LENGTH OF LINES 67L4 ft DISTANCE TO NEAREST WELL /00 ft FOUNDATION /0+ ft PROPERTY LINE 101- 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 it DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ DISPOSAL PONDS WIDTH It LENGTH ft DEPTH ft DISTANCE TO/NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft SEEPAGE PITS NUMBER `7 WIDTH uZ+h ft DEPTH 2S ft DISTANCE TO NEAREST WELL 150 ft FOUNDATION /dfi ft PROPERTY LINE /L)O+' ft I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, ST E LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. MIN M 48 OUR A CE N TI CE REQUIRED FOR INSPECTIONS - PLEASE CALL 209 953-7697 Of SIGNED TITLE '5 DATE q r � DEPARTMENT USE ONLY � '1 Application Accepted B Date '� '� Area ` - — Employee ID# W0A Final Inspection By Date Q F1SPECIAL PERMIT-Approved by Character of Soil to Depth of 3 Ft: Pit1Sump Soil Character: COMMENTS Tic r I- PE SC Received Check#/ Amount Permit/ Code INFO B Cash Remitted Date Service Request# Invoice# Permit ID# 4z 1 o IIS 3 ua zc 5800 199q 42-01• ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18