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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 Joe ADDRESS � — � 7-Cm/ZIP 2 � CROSS STREET r T' 1 1�--Yr 1� APN DUI'O �� / P CEL SIZE / g 7 A I`n n ❑ OWNER NAME .Ot` �q'�`S f�'lI�31� � �I�� PHONE OWNERADDRESS Z�"l� rte'- �1.. �1'1�`.�``- CITYISTATE21P I/' CONTRACTOR 'I' `On S 1�i� ��la�L� A�1� L�nK-r�V Y.� PHONE - Ae--,—- CONTRACTOR ADDRESS ��'i�.l.�{aW\�An.�`TS- CT CCITYISTATE/Z1P T' 1.77i-".,�� cl-s LICENSE ❑❑C-42 ❑❑C36 OTHER G-2` NUMBER ` tP `ktXPIRATION DATE ZO1`l-, WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: ❑ NEW INSTALLATION 0 REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE ❑ REPLACEMENT ❑ OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES:- 1111111 SEPTIC TANK TYPE/MFG CAPACrfY gel #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 -1 LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft DISTANCE TO NEAREST WELL ft FOUNDATION it PROPERTY LINE 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 It 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. MLfJIMUM 48 HOUR ADVAtiCET IR D FOR INSPECTIONS-PLEASE CALL 209)953-7697 SIGNED VIA TITLE `�Z\:�T `",I�.�G' DATE \'-2" t V 3 0 2018 QUIN COUNTY ONMENTAL rt DEPARTMENT DE ARTMENT IYSEO Application Accepted By Date Area Employee ID# Final Inspection By Date ❑ SP IAL PERMIT-Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTSM('l��L PE SC Received hec Amount Date Permit/ Invoice# Permit IDX Code INFO I,— ash Remitted Service Reguest# U 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18