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4k 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 JOB ADDRESS 1 5 E �(C I4Len Ai L r..I;:v C CITYIZIP L O Dr r Z CROSS STREET-/�,`. ALPS/1/,1 i`7 APN r✓, I ??f�L� PARCEL SQE OWNER NAME 71?r"(�TYh/ 1,"-4" PHONE OWNER ADDRESSSTS Sant CITYISTATEIZJP CONTRACTORi/L LCy1/ f'_l i!Tq't II' 3 �EP-F�Ci r1J�, PHONE I/V 22 4- �-I I ��7 yy CONTRACTOR'C42 DDRESS b��7 �)�U/tKrSC-N C17-C-2-t', OIC � �,.�J•t?OL'CnYISTATFJZIP j/�'Ci;'�r�-'slC+-+TD�F,�/�� J LICENSE C 42 C-36 OTHER NUMBER 1072 V Z(,- EXPIRATION DATE/Z C)Z Z- WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y PERC TEST # BUILDING PERMIT# " LAND USE APPLICATION# TYPE OF WORK: V NEIN INSTALLATION FZEPAIRIAD04TION ENGINEER DESIGNED IALTERNATIVE REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: RESIDENCE COMMERCIAL OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: Z NUMBER OF EMPLOYEES: C°U SEPTIC TANK T+—fMFc J" L &' UC f t?E CAPACITY /Z O U gal #OF COMPARTMENTS 2 ❑ GREASE TRAP TY—/MFG CAPACITY gal #OF COMPARTMENTS DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE fl ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) LEACH LINES LEACHING CHAMBERS -IX^102 Ea 11 #OF LINES 2 LENGTH OF LINES SS ft DISTANCE TO NEAREST WELL 1C?0 ft FOUNDATION 2 ft PROPERTY LINE S ft ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION R 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 R LENGTH It DEPTH It DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft df'SEEPAGE PITS NUMBER 2 WIDTH 261 ft DEPTH 7—S ft DISTANCE TO NEAREST WELL /50' ft FOUNDATION (PO ft PROPERTY LINE R 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. U14 48 H01JR A NCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-769 SIGNED TITLEL�15'a�h� DATE D 7/311 ?OZO E yMFN c��VEO G OS 2020 r7jQV�N A EP,gRTp CN7')/ MFNT / DEPARTMENT USE ONLY Application AcceptedElAf 7:7f'L Date Area Employee IN Final Inspection By —.� Date 6 -ZvZO SPECIAL PERMIT-Approved by Character of Soil to Depth of 3 Ft: PItlSump Soil Character: COMMENTS too:,V r!-;1 •'I t G t+, '051)74 Y. S F Q- ,t'i ]1.. 3,r'101y /�?c•xrtwu`n v��l ('-�c�� vrr chc;1�,�, tyT�y�fr,•+l is ;�y �.+tlle3- PESC Received Check#1 Amount Date Permit/ Involce# Permit]DO Code INFO B Cash Remitted Service Request# d 4L.01 -7� ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4!1418