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(L NSrrE WASTEWATER TREATMENT SYSTEM PERh fT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 NON-REFUNDABLE PERMIT C LL(20T 953-7697 FOR INSPECTIONS EXPIRES 1YEAR �yFROM DATE ISSUED JOB ADDRESS CITY/ZIP �f (J r ota3c� CROSS STREET 1 (� 14— IL 27-,{ APN PARCEL SIZE i G OWNER NAME - Tet- 111 ��LifV j .refs he o PHONE eh 1 IIQ! f OWNER ADDRESS � � S��.e CITY/STATE/ZIP �/UGKP2 /b�17f' CONTRACTOR /�� i � /� �JJ�/liy 1J..x-fi PHONE CONTRACTOR ADDRESS 167a20,'_4 r AIIA AZ �b CITY/STATE/ZIP..2i�L� 5 LICENSE 111-IC-42 ❑LIC-36 OTHER NUMBER EXPIRATION DATE A, !y WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # I BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: C NEW INSTALLATION �C?/ REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE CI REPLACEMENT n OUT-OF-SERVICE SEPTIC SYSTEM ❑ DESTRUCTION INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: C;� NUMBER OF EMPLOYEES: IJ SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS O GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft L11 LIFT STATION SIZE TYPE OF PUMP 0 PKG TX PLANT ® SAND OIL SEPARATOR(ENCLOSED SYSTEM) LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES�� ft l DISTANCE TO NEAREST WELL ft FOUNDATION / ft 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 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 P�' WIDTH l� ft DEPTH.2-5----, 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. MIN 48 HOU V/AN E NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL 209 953-7697 SIGNED TITLES DATE — 4. V I1. C D DEPARTMENT U E ONLY Application Accepted By Date-7/,q/,;0&Q Area y C9C Employee ID# D Final Inspection By / l Date '7"/7-2074 ❑ SPECIAL PERMIT -Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS F4ilinA IMe/91L)W. -r1,Y'X1r _ PE SC Received (eh eck# Amount Date Permit/ Invoice# Permit ID# Code INFO By Remitted I Service Request# ga a 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18