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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 7 JOB ADDRESS -_ 2 ) z `� S CITY/ZIP �� L l J` CROSS STREET btj r G1 MY1 ,{r APN 3 3 U��% �7 PARCEL SIZE J C' OWNER NAME r�� ( ^ PHONE OWNER ADDRESS Su 1",'te CITY/STATE/ZIP v CONTRACTOR ,A�/e h/�P_ �'C/�✓�' C. c¢ ✓��/` PHONE j - IF CONTRACTOR ADDRESS / ` / /��i`�✓ J �� / CITY/STATE/ZIP '17C1(�. �.�� /f l�J ,J' LICENSE 11-C-42 ❑FIC-36 OTHER NUMBER 7/J /J_3 EXPIRATION DATE2 WATER TABLE DEPTH:' 070 4 T I ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT## LAND USE APPLICATION## TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE ^sr REPLACEMENT �''T'"(C OUT-OF-SERVICE SEPTIC SYSTEM 47 DESTRUCTION Z/ Y`•' INSTALLATION WILL SERVE: L RESIDENCE El COMMERCIAL C OTHER NUMBER OF LIVING UNITS: / NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: Z1 SEPTIC TANK TYPE/MFG CAPACITY 76-c)J gal #OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS DISTANCE TO NEAREST: WELL — ft FOUNDATION .S ft PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) ❑ LEACH LINES I LEACHING CHAMBERS #of LINES LENGTH OF LINES ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE 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 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 448 HAUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS -PLEASE CALL (209)953-7697 SIGNED /��--�. TITLE [ _Sr't�✓ �i DATE 2-1Zc " i 1r DEPARTMENT USE ONLY _ Application Accepted B Date iIjZjXqjj13 Area 5 Employee ID# 61 Final Inspection By Datel C SPECIAL PERMIT-Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS fc11 tine Of 1-i vlik - 01AL V� ;V) 01a Oti► Ca -O cl ton4cL e L , PE SC Received // Amount Date Permit/ Invoice# Permit ID# Code INFOash Remitted Service Request# LjaOq 115- B Tl0 FT 42-01 / V V''• tl- 1 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18