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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAS OUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 NON-REFUNDABLE PERMIT CALL(209)953-7897 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS _ EALj!_�D R —CITY/ZIP_ CROSS STREET ��[Py2I'1 IF S APN PARCEL SIZE €y OWNER NAME_�f✓`JiA S ✓I7 CN� PHONE OWNER ADDRESS 59,,,- CITY/STATE/ZIP CONTRACTOR emiv.TV%_LcTjZDrJ SEt <::"o LrIJG, ___ PHONE ` CONTRACTOR ADDRESS SS?2 MkRmse'v ejzarl(< Lj A_ 5C4J'e 0,00 _CITY/STATE/ZIPfx/t --"V a /L� �2 g LICENSE I 1.-4Z J C-36 OTHER NUMBER 7 ZZy3(e, EXPIRATION DATE„ WATER TABLE DEPTH:�� (�" _____._ ft GEOGRAPHICAL INFORMATION: Coordinates X Y PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: --NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ LT-ERfjAAT�IIV/% R \ EPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM X DESTRUCTION INSTALLATION WILL SERVE: RESIDENCE COMMERCIAL OTHER NUMBER OF LIVING UNITS: 1 NUMBER OF BEDROOMS: _ _ NUMBER OF EMPLOYEES: SEPTIC TANK TYPE/MFG CJ i4z e.1 Z SQL) CAPACITY Z S-bp gal #OF COMPARTMENTS 2— ❑ 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) all LEACH LINES LEACHING CHAMBERS 3`y�a+/ofo� ia.�J #OF LINES�� LENGTH OF LINES (P�� ft �V ' ` i I DISTANCE TO NEAREST WELL 100 §I fr_FOUNDATION 2p ft PROPERTY LINE S 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 ❑ SUMP$ 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 LQ SEEPAGE PITS NUMBER y WIDTH 60'', ft DEPTH -z S ft DISTANCE TO NEAREST WELL /�6{ ft FOUNDATION FG ft PROPERTY LINE IZD' ft 1 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. SIGNED TITLE P_'e J;610"t DATE 0'/,-3k/2-02r-1 IV n"M r a S Q N N R DEPARTMENT' U1BE ONLY Application Accepted y Date /11ZO7� Area Employee ID# Final Inspection By ` Date I SPECIAL PERMIT-Approved by Character of Soil t Depth of 3 F._ PiUSrmp$oil haracter: , COMME1NTS e Q C ( L_ w67T— OQu li r {/ it'V 'f Li S t,'/LQ_ CO✓Lt"It a PE SC Receive Check Amount Permit/ Code INFO B ash Remitted Date Service Request# Invoice# Permit ID# 42-01 �Ou'5e_ VA) ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18