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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 GT. CITY/ZIP L`TbO_� 9S L12 CROSS STREET S/f 7 PPEE APN Q O S SLoO D'Z- PARCEL SIZE I• • a A p.-, .�,. Q A.,ww ,0 0 OWNER NAME Jc/JA THA^u CA-x r ePJ he&-VV`� (_McC 1,V-i PHONE y OWNER ADDRESS E CITY/STATE/ZIP CONTRACTOR LIVE O A-K GTG0E-^yl.V')X07-+&1 E►y'TP1 L PHONE 31 5`O3-7- p, CONTRACTOR ADDRESS �01 W 0`,`�"� CITY/STATE/ZIP Lob( CA I S Z'4 U LICENSE ,- C-42 C-36 OTHER ��U NUMBER Z I S ) EXPIRATION DATE 4-.3o- L2_ WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y PERC TEST # I BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITIONI ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM I: DESTRUCTION INSTALLATION WILL SERVE: RESIDENCE a COMMERCIAL L OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPE/MFG CAPACITY gal #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 LEACHING CHAMBERS #OF LINES LENGTH OF LINES DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ❑ FILTER BED WIDTH ft LENGTH ft DEPTH 1 i^D DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINEY ft c ❑ MOUNDED WIDTH ft LENGTH ft DEPTH tU 2 DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft / 2020 ❑ SUMPS WIDTH ft LENGTH ft DEPTH AN DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE N A USN COIL ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH �T1 M E ARTTAL TM DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft MENTI ❑ 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. MINIMUME NOTICE RE UIRED FOR INSPECTIONS-PLEASE CALL 2 SIGNED TITLE PRaJ M G72 DATE ��2, Z0 DEPARTMENTEONLY Application Accepted By L� Date � r� Area Employee e ID# D Final Inspection By Date -7-/6-264' ❑ SPECIAL PERMIT-Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS PE SC Received Chec Amount ate Permit/ Invoice# Permit 1D# Code INFO Bv ash Remitted P Service Request# LI� 5a3 2 iso 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18