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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 � �f ./ y �J CITY/ZIP ``�� J C G j CROSS STREET APN zZ� V PARCEL SIZE 33-3 Y 0 OWNER NAME �4v R* f (- f `4 [/y- PHONE S OWNER ADDRESSC� Q �!� CITY/STATE/ZIP' CONTRACTOR ► {t 1 _�IC"�,�r S-�[. PHONE CONTRACTOR ADDRESS \� ��k� .� :� CITY/STATE/ZIP �,`a ✓f%gL.t{- , G /q r? �( LICENSE LIIJC-42 ❑CIC-36 OTHER NUMBER 1 EXPIRATION DATE WATER TABLE DEPTH: `� V ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION Li ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT I-I OUT-OF-SERVICE SEPTIC SYSTEM I I DESTRUCTION INSTALLATION WILL SERVE: ESIDENCE ❑ 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 LINES I LEACHING CHAMBERS #OF LINES LENGTH OF LINES �c7 ft DISTANCE TO NEAREST WELL I f ft FOUNDATION it PROPERTY LINE i;S 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 tdr SUMPS WIDTH r ft LENGTH �� I ft DEPTH 16 ft DISTANCE TO NEAREST WELL 15;,� ft FOUNDATION (;3' It PROPERTY LINE ?s r ft ❑ DISPOSAL PONDS WIDTH ft LENGTH it DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE 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 HOU ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL 209 953-7697 SIGNED TITLE rC« r DATE (r'J ) 1 r D 19 A UjfV E r N M p DEPARTMENTUS ONLY Application Accepted3y Date 2 1 < Area 44? — Employee ID lA Final Inspection By Date 1 0 � n ' 2a,`5 El SPECIAL PERMIT-Approved by Character of Soil to Depth of 3 Ft:LAK" blkiw-0 S""1 I S �• Pit/Sump Soil Character: CONIMENTS (,J 7 1A/f 5 U"\k� z v-� PE SC Receivedeck# AmountPermit/ Code INFO B s emitted Date Service Request# Invoice# Permit ID# 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18