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e ` ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 NON-REFUNDABLE PERMIT �1 CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS f0z WF-ST �Ds�PFf �D• CITY/ZIP M,4A1TEGA 9533!0 ^, J m CROSS STREET Y• �IA�IY Sr./' ATL! APN oLI G -31 D —160 PARCEL SIZE 9-6U o OWNER NAME Krtl1N �L'/V iI WeATH I PHONE,�O9- /'G9 -.2;+(, ,/ v OWNER ADDRESS F, 0 •Jj-Y 4•a 33 CITY/STATE/ZIP /►9ANTFe 4 CI-53.37 CONTRACTOR CH ES E�fzNSucT-,(&1 , PHONE ,7d�- x{-02- 165-2 CONTRACTOR ADDRESS • O • 130 X 371+ CITY/STATE/ZIP 77,(RL� C4 a:529/ LICENSE DIC-42 ❑ 1" CIC-36 OTHER —E NUMBER s 7 EXPIRATION DATE #Oo /a DZ/ WATER TABLE DEPTH: ti ft GEOGRAPHICAL INFORMATION: Coordinates X Y PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: I I NEW INSTALLATION REPAIR/ADDITION Ll ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM I DESTRUCTION INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL CI 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 '7 �` DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE cz fT!� • At ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE qN � ❑ MOUNDED WIDTH ft LENGTH ft DEPTH dqAq DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE HRS,VCl�yy,, T� ❑ SUMPS WIDTH ft LENGTH ft DEPTH � 7At r DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINEN ❑ 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. M UUM 4 R ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-76%2aar)SIGNED TITLE of✓I L E/��9�11(EEI� DATE ILI ou � w t-� P DEPARTMENT USE ONLY Application Accepted By Date W Area Employee ID# Final Inspection By Date Z)ZO C SPECIAL PERMIT-Approved by Character of Soil to Death of 3 Ft: PiUSUmp Soil Character: COMMENTS y�o� g Wj pJj (LQ(j Z DOA , LL5 30 ;A , . `( r L me hacc Vj&&dry PE SC Received Chec Amount Date Permit/ Invoice# Permit ID# Code INFO By ash Remitted Service Request# 42-01 � t �S , O'e*(,Iz fka L'rL I�t� 'S Wlp ` y it1l+�� /� '('),� /� Ln y ,//.� l �y� [�� ./} ONSITE WASTEWATER TRTMNT,S�YS`TlE 'I�ERMIT//� 4/14!18 ( :?D , K Q-z� OXY �l�e. - 1 V �� S - k t S b�� f •';5 5qy, C- Cie