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• 1 ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 NON-REFUNDABLE PERMIT /f CALL(209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS �lI' Sin 6��/1 �(/�1 {� �,� CITYY///ZZIIPP1 CROSS STREETO{� AP �(/J`�v v / / PARCEL SIZE c OWNER NAME ��77 QQ(,,�� 1/C d,../ �� /) PHONE OWNER ADDRESS [J .S _ I/AA/ F7 II 1P1A CITY/STATE/ZIP / ! CONTRACTOR I Y I I S l mail j� �• PHONE LI / �r}'S8zL .- CONTRACTOR ADDRESS A2&,N Ar 7N CITYISTATEIZIP "I /G'✓fV Cmc.✓7 '�G'� � �� LICENSE LLIC-42 ❑i 1C-36 OTHER NUMBER(P6'IS�_EXPIRAT(ON DATE}t) WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: COordl Ates X Y PERC TEST # BUILDING PERMIT# O AND USE APPLICATION# TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: RESIDENCE I I COMMERCIA�LJ LI OTHER NUMBER OF LIVING UNITS: I NUMBER OF BEDROOMS: -1 NUMBER OF EMPLOYEES: 0 SEPTIC TANK TYPE/MFG /�V CAPACITY 1(0 dD gal #OF COMPARTMENTS ❑ GREASE TRAP TYPE-/MFG CAPACITY gal #OF COMPARTMENTS �r DISTANCE TO NEAREST: WELL I jsn I ft FOUNDATION 371 ft PROPERTY LINE yh ft �v ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) LEACH LINES LEACHING CHAMBERS #OF LINES U LENGTH OF LINES ft DISTANCE TO NEAREST WELL lin t ft FOUNDATION 4.6' ft PROPERTY LINE S I 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 ❑ SUPIIPs 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 PROPERTYLINEft SEEPAGE PITS NUMBER 4 WIDTH--3e-,,,t ft DEPTH � ft DISTANCE TO NEAREST WELL__t e 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 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS -PLEASE CALL (209)/9/53-7697 SIGNED 1, TITLE DATE I 011 Oq G N � P q T • EPARTMENTUS F1 ONLY Application Accepted By Dateff4qqjtArea Employee ID# Av�40&A Final Inspection By ► L-_ Date 2� _ ❑ SPE IAL PERMIT-Approved by Character of Soil to Depth 3 Ft: Pit/Sump Soil Character: COMMENTS'/fNl 'ZL�(J�/A Thr CSAwIAeod - PE SC Received hec Amount Permit/ Code INFO B Cash emit ed Dnate� Service Request# Invoice# Permit ID# �1 S 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18