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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 ' "t rr'' -7S L ! CITY/ZIP 1 Yl J Z' l4 CROSS STREET _ Flye"'id I (Amp APN t�0310 017 PARCEL SIZE f olC Y /�l,, rr O OWNER NAME rV e,�C�,-1? Jer n tt'r DC'1�hCl PHONE �' Ij OWNER ADDRESS P. y P"')? 1 � /- CITY/STATE/ZIPKwz CONTRACTOR ;i��-LtJ /�� ctq,r I+ar* Spiro PHONE `/ �(Y� CONTRACTOR ADDRESS r V y� NI /� J r CITY/STATE/ZIP JAI c1�llffi[Z/� �C-✓� '3:j LICENSE ❑LC-42 ❑I IC-36 OTHER Y- NUMBER 5J EXPIRATION DATE I t n•43'I ] WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT#EP-00 0)-?& LAND USE APPLICATION# TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION Ll ENGINEER DESIGNED/ALTERNATIVE I REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM ❑ DESTRUCTION INSTALLATION WILL SERVE: RESIDENCE 11COMMERCIAL 11 OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: H NUMBER OF EMPLOYEES: SEPTIC TANK TYPE/MFG Ak I- CAPACITY Ito L gal #OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS � t I DISTANCE TO NEAREST: WELL I�{I ft FOUNDATION , ft PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) W LEACH LINES LEACHING CHAMBERS #OF LINES 3 LENGTH OF LINES J7 t ft DISTANCE TO NEAREST WELD ft FOUNDATION 4,.5 ft PROPERTY LINE 5 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 Ill' SUMPS X WIDTH v1- ft LENGTH 0�I ft DEPTH hof ft DISTANCE TO NEAREST WEL101 — ft FOUNDATION ) ft PROPERTY LINE S ft ❑ DISPOSAL 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 1 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 ADVAAfCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 SIGNED TITLE C.41a dh Z -,0C_ DATE l O - I q -- a 4: ^ SN � , E V /N N fvT DEPARTMENTUSEONLY Application Accepted By GL Date a sIdO" Area —q) Employee ID#_D Final Inspection By A Date 10 CJ✓• C SPECIAL PERMIT-Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS A),,w SER, I ger r S m ADper- ltd CWI!leC 71141ao:20 HiW S T5 De i5" geoIw rmm d `„ ' '< LI(( In �Sc�u v-v&il ,:4eeP.�ic PE SC Received Check# Amount ate Permit/ Invoice# Permit ID# Code INFO B _ Remitted Service Request# a b l » S8 15 2 5V-0D'9 2-4-3"1 42-01 _.!SITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18