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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 JOB ADDRESS ` �• y t'e-uj i10 CITY/ZIP T&-O- r , -5-1+ '75-32& LA ^ ``,, CROSS STREET corre"I f7J 104 APN L�'L�'O 731--QS' PARCEL SIZE 0 d C OWNER NAME Dr au r k L10A rYv 3 ►neA PHONE 7 OWNER ADDRESS ' V�J ! '�� V)I)i j 't CITY/STATE/ZIP llt"L,/ Cf"S7 N CONTRACTOR �� "1�"� .s{� S-LI' PHONE Y'ISSCO CONTRACTOR ADDRESS � iN CITY/STATE/ZIP 6 no`�cs9 L✓} `� zy-!C LICENSE ❑11C-42 ❑ //CIC-36 OTHER NUMBER(00SZ1 EXPIRATION DATE. WATER TABLE DEPTH: I I ft GEOGRAPHICAL INFORMATION: Coordinates X ��VY C PERC TEST # BUILDING PERMIT# aOb 1676 LAND USE APPLICATION# TYPE OF WORK: jr NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE ❑ REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL C OTHER NUMBER OF LIVING UNITS: I NUMBER OF BEDROOMS: ; l NUMBER OF EMPLOYEES: 6k--SEPTIC TANK TYPE/MFG &/, CAPACITY / "'JL_ gal #OF COMPARTMENTS_ ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS DISTANCE TO NEAREST: WELL— InOfi ft FOUNDATION ja ft PROPERTY LINE . I ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) LEACH LINES ❑ LEACHING CHAMBERS #OF LINES s _ LENGTH OF LINES Jlt� ft DISTANCE TO NEAREST WELL ( 50.j.Y ft FOUNDATION _37 ? ft PROPERTY LINE J i 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 �r aSUMPS WIDTH ;X� ft LENGTH u! ft DEPTH My ft DISTANCE TO NEAREST WELLSD7+- ft FOUNDATION IfS't ft PROPERTY LINE S a ft ❑ DlSPOSAL 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. MINIMUM 48 HOUR A ANICE NOTICE REQUIRED FOR INSPECTIONS -PLEASE CALL 209 953-7697 SIGNED TITLE �� ./YIc_Iy� DATE YG � If j C. 6 INC U HD J DEPARTMENTUSE ONLY Application Accepted By l2✓ Date 8 70 Area Employee ID# Final Inspection By Date �� Fs 0 C SPECIAL PERMIT-Approved by Character of Soil to Depth of 3 Ft: Pi Sump Soil Character: COMMENTS /J(--\,J SFR- '(✓r . I WL!, ,tt�jut ti.i\A o' W PE SC Received Check Amount Date Permit/ Invoice# Permit ID# Code INFO Remitted Service Request# Lid 13 fly 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18