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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 t R 3D I S Ilf-YYfnylf.Vj COL1rfi CITY/ZIP L-�QWI QyTts CROSS STREET r/'fJ(•�[_� 00 APN a//"/ ?�Q S- / n'/ �A ` 1�f�� ,( PARCEL SIZE �/ d OWNER NAME ' '1� �ILC.1K V /�-(f'n/�y.{"�/��y iz-, PA-r-r(fc,- PHONE OWNER ADDRESS`n II �j�.� 'J`n ��.�V��+�///��'�`� CITY/STATE/ZIP `/> ♦ /�ys- �7 Qy CONTRACTOR V Vr�\ �W� 1�/1�1��Y �}�-Pi PHONE(?_ J� 3301 In� `�{4 -7' I (� CONTRACTOR ADDRESS UV/ `1 CJI CITY/STATE/ZIP I—C k ` CA l'52-`-1� LICENSE ❑' C-42 ❑ C-36 OTHER /'1 NUMBER J EXPIRATION DATE LC ZL (4-0 WATER TABLE DEPTH: l V ' tel. 01 ft GEOGRAPHICAL INFORMATION: Cnates X Y ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: NEW INSTALLATION R PAIR/ADDITION IJ ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM EI DESTRUCTION INSTALLATION WILL SERVE: K RESIDENCE i I COMMERCIAL n OTHER F NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: ✓-7 NUMBER OF EMPLOYEES: t� L SEPTIC TANK TYPE/MFG r L CAPACITY W� gal #OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS DISTANCE TO NEAREST: WELL �7L ' ft FOUNDATION ft PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) Gd LEACH LINES LEACHING CHAMBERS IN�� h�b`2S #OF LINES `l LENGTH OF LINES-15'i=ii` ft DISTANCE TO NEAREST WELL '5(D ft FOUNDATION �I'f ft PROPERTY LINE `O 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 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 ft SEEPAGE PITS NUMBER 1 WIDTH _j -Lw, a r ft DEPTH 25 ) ft DISTANCE TO NEAREST WELL 05 / ft FOUNDATION ]0 ft PROPERTY LINE <f4 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 HOURADVANCE NOTICE REQUIRED FOR INSPECTIONS- PLEASE" CALL 209 953-76"97 SIGNED TITLE ��t)1>°G�' C(�17rd lnc�cY DATE `1 I U EA VI O E E 01.IMi NT kL HEA LH C El:;RMN Ir- 1 1+ EPARTMEN U E ONLY i n Application Accepted By Date Area Employee ID# Final Inspection By �� Date 2 Z v 2 G SPECIAL PERMIT-Approved by Character of Soil to Dept# of 3 Ft: Pit Sump Soil Character: COMMENTS PE SC Received heck Amount Date Permit/ Invoice# Permit ID# Code INFO n B S Remitted Service Request# A r 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18