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L' L 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 .11 a 99 / nk i ro`o �. � CITY/ZIP �yJ✓� �� d j CROSS STREET �1�61✓1 wT Vdk- APN_67 10 Z� PARCEL SIZE .C) C C OWNER NAME ,1 C7 Sala Imo/ JPHONE OWNER ADDRE((SSSSS'V a>C, CITY/STATE/ZIP v CONTRACTOR G� 1 l��'" Cr PHONE 16cl-��Z CONTRACTOR ADDRESS ��/� �TvU/' 7/�i�� L7.t CITY/STATE/ZIP LICENSE ELL-42 1111C-36 OTHER NUMBER SEXPIRATION DATE h WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X TT Y ❑ PERC TEST #_ BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: NEW INSTALLATION 0 REPAIR/ADDITION I i ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT IJ OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION �/ INSTALLATION WILL SERVE: RESIDENCE COMMERCIAL OTHERAO-0_%!5jeg f //�Avf NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ,cwL SEPTIC TANK TYPE/MFG CAPACITY JiatJD gal #OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS DISTANCE TO NEAREST: WELL It FOUNDATION It PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP rlt❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) LEACH LINES D LEACHING CHAMBERS #OF LINES_ LENGTH OF LINES ft DISTANCE TO NEAREST WELLft FOUNDATION It PROPERTY LINE %LID ft FILTER BED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ SUMPS WIDTH ft LENGTH It 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 It SEEPAGE PITS NUMBER g WIDTH ! o� ft DEPTH ft DISTANCE TO NEAREST WELL I x' it FOUNDATION '/!J ft PROPERTY LINE�J/]/S^ 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 H UR ADVANCE NOTICE REQUIRED FOR INSPECTIONS- PLEASE CALL 209 953-7697 SIGNED TITLE of i" x� DATE hr Ila N AE T L H H E A 8 ARTMENT S O LY Application Accepted B Date Area Employee ID# Final Inspection By Dat'-IlfbIn 11 SPE IAL PERMIT-Approved by Character of Soil to epth of 3 Ft: Pit/Sump Soil Character: COMMENTS ) � '� 1-00r ,t �J PE SC Received Check#/ Amount ate Permit/ Code INFO C sh emitted Service Request# Invoice# Permit ID# 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4114/18