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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 2 9 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS CITY/ZIP CROSS STREET �a{- APN d cX G (�J 3j, PARCEL SIZE 1' 00 OWNER NAME I �}�/1]/�AA (91`� PHONES OWNER ADDRESS CW Q�I(�'.►'"1 ' CITY/STATE/ZIP Xn/- CONTRACTOR CYtl�b'1�11- + SON' PHONE_Q 0 9 —'/r�1�r3(�� /��/tJ 1/J ( // CONTRACTOR ADDRESS L 1 6 1 � -�T' CITY/STATE/ZIP D b l� 1 I V C4 q g 7'Y LICENSE ❑i_:C-42 ❑I_I C-36 OTHER CZ NUMBER(�d� t9 EXPIRATION DATE �-a/31 l ao WATER TABLE DEPTH: 1,5s -01er, d') ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: ❑ NEW INSTALLATION REPAIR/ADDITION I I ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT Ldc'c I OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: l RESIDENCE ❑ COMMERCIAL E OTHER NUMBER OF LIVING UNITS: ,�� MBER OF BEDROOMS: Q NUMBER OF EMPLOYEES: L3 SEPTIC TANK TYPE/MFG flyJ D PX 15t1�� CAPACITY gal #OF COMPARTMENTS Z ❑ 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) Q ! LEACH LINES ' LEACHING CHAMBERS #OF LINES LENGTH OF LINES C�D ft DISTANCE TO NEAREST WELL ft FOUNDATION 1 f ( ft PROPERTY LINE /Q/ 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 ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE 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 It DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft I HEREBY CERTIFY THAT IHAVE EPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, S E LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. MINIMUM 48 OUR A A CE NOTICE REQUIRED FOR INSPECTIONS -PLEASE CALL 209 953-7697 SIGNED r TITLE �y(/�YLI DATE Q F H DEPARTMENT USE ONLY A Application Accepted B - l� Date t �3 Area .� 9l Employee ID# Q Final Inspection By Date 2020 ❑ SPECIAL PERMIT-Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMEN TS u.e J lewh CeIcY fr�fCC) kIca '10 6e-,vh(r:ble c, e- 40 relQc ii sysl�w�� AC— - �E�a�tl�$ Y✓ILiC%�e IN IJP�WpPl� t'x15�l�4 11neS �X1�1 /vl(. JIIIeC Le�gh(illa(pilf' aige .qc, y,Dr of (7� P2.t t ror^ l./PI� f�leY re Lxisl �i ' PE SC Received Check#/ Amount Permit/Code INFO B Cash Remitted Date Service Request# Invoice# Permit ID# Liar I!s 30�D YD 0"L SOK-t-A dp- 42-01 ONSITE WASTEWATER TRTMNrT-eSYSTEM PERMIT 4/14!18 i� 1 �Y � / f� U � V �� V '