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ONSITE WASTEWATER T.rIEATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT ♦ 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)4683420 NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOBADDRESS Z^-�> U/ / l CITv/zIPJ_¢y�f�,( ( utAuEL CROSS STREET ,LJ �1C^"C/1� k(A l APN V�/3%),J G' PARCELSIZE g OWNER NAME \,f ,NA ^�-32"--10-5 PHONE\`�� (-F IT/� CcC(p OWNER ADORE L/SS CrY/STATEZP \ �-7C G� i,2'(,y CONTRACTOR[��r[�1�/� � �}Z�j_ CL�iS�Yl)C- UY� ��-J/✓- PHONE( CONTRACTOR ADDRESS CITY/S7ATE/7JP GF 1 LICENSE ❑_iC-42 ❑-C36 OTHER f NIJMBERCTE� .-)L+' EXPIRATION DATE WATER TABLE DEPTH: It GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: ._ NEW INSTALLATION REPAIR/ADDITION I.: ENGINEER DESIGNED IALTERNATIVE REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: SEPTIC TANK TYPE/MFG L✓ ( b— CAPACITY 1 SL� gal #OF COMPARTMENTS l ❑ GREASE TRAP TYPEIMFG +'Vt44i C, G�-YCZ 'kLih C- )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 -LEACHING CHAMBERS_ #of LINES LENGTH OF LINES_ ft DISTANCE To NEAREST WIT _ It FOUNDATION_ _ft PROPERTYLINE ft FILTER BED WIDTH -I ft LENGTH .3't ft DEPTH DISTANCE T^NEAREST WELL /, �" _ft FOUNDATION �7D It PRnPFRTY I INE ft ❑ MOUNDED WIDTH It LENGTH "�` ft DEPTH It DISTANCE TO NEAREST WELLft FOUNDATION ft PROPERTY LINE R ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION It PROPER7YLINE ft ❑ DISPOSAL PONDS WIDTH ft LENGTH It DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTYLINE ft ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTYLINE 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 CALF(20919153 7697 � SIGNED ='lL� T�(-y'vt C_ TITLE I I a4 gYM,14AY 18M N� NSR QUIN P4 T) I J DEPARTMENT VSE ONLY Application Accepted �'— 1_ Date S ji' .J Ll� Area �/(� Employee ID# ) � Final Inspection By Date ❑ SPECIAL PERMIT-Approved by Character of Sol]toDepthof 3 Ft: PIM p SOII haract COMMENTS/ C �11/L;-e_. /� ;k /Ui ^VI C/' ln4G'i' PE SC Received Check#/ Amount Date Permit/ Invoice# Permit ID# Code INFO 6 Cash .Remitted Se ice Request# yam" i l' 3j 1>1 -5 n 42.01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18