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t ' ONSITE WASTEWATER TREATMENT SYSTEM (PERMIT SA4C}AQ�II�IbUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 N jKK��E``{{FF UUD LE ERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE_ISSUED JOB ADDRESS / 1-1p Z> d CITY/ZIP 1 �J � p �' n (� J � CROSS STREET 1� N `- f` Qr�—v A4> APN syj9 000 �/ ? SPA"R'CEL SIZE E a .��3/,_7� c OWNER NAML y"c � S C� I PHONE zyQ (L� 5]' / OWNER ADDRESS ` J •�� D A?00 CITY/STATE/ZIP ^ p,� T CONTRACTOR u `' � PHONE <;:4fr? 610 CONTRACTOR ADDRESS CITY/STATEIZIP LICENSE D1-IC-42 ❑0C-36 OTHER NUMBER EXPIRATION DATE WATER TABLE DEPTH:/OS r( • ft GEOGRAPHICAL INFORMATION: Coordinates X Y PERC TEST # BUILDING PERMIT# D LAND USE APPLICATION# TYPE OF WORK: I NEW INSTALLATION u REPAIRIADDITION LI ENGINEER DESIGNED/ALTERNATIVE 0 REPLACEMENT 0 OUT-OF-SERVICE SEPTIC SYSTEM I_I DESTRUCTION INSTALLATION WILL SERVE: RESIDENCE 0 COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: 3 NUMBER OF EMPLOYEES: 1�--SEPTIC TANK TYPE/MFG L' CAPACITY 'EJ�' 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 0 LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It FILTER BED WIDTH 12-0 ft LENGTH �eg ft DEPTH LA I, ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE SO 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 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 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL(209) 953-7697 Q SIGNED TITLE DATE /0 - 20, ^ — P n — — — A N ARTMENT SE N Y y Application AcceptedXB % EPq Date l Area 1 / Employee ID#�U�? Date 79 0 SPECIAL PERMIT-Approved b Final Inspection By pp y Character of Soli to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS - e !oo�j be cf/� f•��c_-d wu( rev �QiV► �Or�n�:P/1/e it _r� N • � !l�I� T PE SC Received iec Amount Permit/ Code NFO B ash Remitted Date Service Request# Invoice# Permit ID# yj.li 11 M533o gfq S 0 42.01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18