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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 95202-(209)468-3420 NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS ( Z , w• P L ArT I R-t • CITY/ZIP TR-A Ly Iq 7 Jy CROSS STREET t-`kw"rA E R� APN 2-1 PGARCEL SIZE , Amy • p OWNER NAME �` C—^L•L'f, PHONE �tO 3;u-4O,44 OWNER ADDRESS ZAP • �Fy,L�A- r r "' p- CITY/STATE21P I C A ciS-3o L+ CONTRACTOR G�i 17E1VV�t'Z-DNIW1�N«L PHONE 3(99-01'* CONTRACTOR ADDRESS �1 - V^ ST' CIN/STATE/ZIP LICENSE C-42 1C-36 OTHER NUMBER EXPIRATION DATE WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y PERC TEST #___L__ BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: NEW INSTALLATION REPAWADDITION ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT II DESTRUCTION INSTALLATION WILL SERVE: RESIDENCE COMMERCIAL I 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 It ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) ❑ LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE ft ❑ FILTER BED WIDTH It LENGTH ft DEPTH It DISTANCE To NEAREST WELL It FOUNDATION ft PROPERTY LINE It ❑ MOUNDED WIDTH It LENGTH ft DEPTH It DISTANCE To NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ SUMPS WIDTH It LENGTH ft DEPTH it DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH It DISTANCE To NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ SEEPAGE PITS NUMBER WIDTH It 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. I M/y/,UR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 Z SIGNED /''�` TITLE �ON�K•T W 7- DATECie /QED ,�' "DESIGNATED REMAINDER" g3 R (� 2020(� I QUIN/CI, -[aPARCEL•," 39t °k .�.e.,. "ART L oy ;� EA.7 I ENT I M 4 ? R PLATT D DEPARTMENT US OTY Application Accepted y Date Nk Area Employee ID# Final Inspection By Date SPECIAL PERMIT-Approved by Character of Soil to pth of 3 t Pit/Sump Soil haracter: COMMENTS J 06 PE SC Received Amount Date Permit/ Invoice# Permit ID# Code INFO Rif, Clash Remitted,r..11 Service Request 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT