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t � ONSITE WASTEWATER TREATMENT SYSTEM PERWT 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 CITYIZIPe- �i 377 CROSS STREET 6d9-r /,/G_ AP N L (/V r PARCEL SIZE s 515 2 C OWNER NAME J!J(,C�/) CJQ/��(��j��`/ PHONE -yOB- y,&l OWNER ADDRESS CITYISTATE/ZIP CONTRACTOR Sae„"z, �r SQ7y l�lG7I(�n .c-/► PHONE_-,",09 -911- 50M5 /J 2 CONTRACTOR ADDRESS I S I3 I Ol r (5 e !�'d. CITYISTATE/ZIP _%�"GtLL/ G4 - LICENSE ❑LIC-42 Ell-IC-36 OTHER L NUMBER SW.�l EXPIRATION DATE (p/-'1 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/ALTERNATIVE ,-r- REPLACEMENT n OUT-OF-SERVICE SEPTIC SYSTEM 9r- DESTRUCTION INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL -:7 NUMBER NUMBER OF LIVING UNITS: J /t NUMBER OF BEDROOMS: v NUMBER OF EMPLOYEES: SEPTIC TANK TYPE/MFG P� L CG,,,G( e,-k— CAPACITY 49040 gal #OF COMPARTMENTS 1.2 U 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 E3 SAND OIL SEPARATOR(ENCLOSED SYSTEM) 1-3 LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft _ b FILTER BED WIDTH _ /1 ft LENGTHy0/ ft DEPTH DISTANCE TO NEAREST WELL_ 150�'_ ft FOUNDATION _ �G ft PROPERTY LINE j. ft L2 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 ® DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE Ca SEEPAGE PITS NUMBER WIDTH ft DEPTHJ'JAft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE AN JnA 2I2 I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN C Ivry STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. ��, STI♦DEPA AE MINIM014 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209953-7697 NT SIGNED TITLE DATE G e EPARTMENT USE ONLY Application Accepted By Date g ZO Z DArea 12 Employee ID# Final Inspection By Date 7o,4 ❑ SPECIAL PERMIT-Approved by Character of Soil to DeptA of 3 Ft: Ph/Sump SoilCI}raractgr: COMMENTS ,\ f��(-- �—i//"" -6 T,1 kr bed ,F 6 B as o. 0,YI t , x PE SC Received heck Amount Date Permit/ Invoice# Permit ID# Code INFO B as Remitted Service Request# -3 300 7,cw 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18