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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 r CALL 209 953-7697 FOR INSPECTIONS �J EXPIRES 1 YEAR FROM DATE ISSUED JOBADDRESS /-/ 3�� TpIZEDE2IGK AV� CITY/ZIP / /[�PO/lI /S3GG CROSS STREET �"' ES r g/I c?x API �5-7—9(p-aZ ,P40 PARCEL SIZE O / O OWNER NAME `L F_F_N N PHONE -109 / ^ v, OWNER ADDRESS 3�(� S• �l2ED J✓2 fG L� CITY/STATE/ZIP /Z/PON CA Is-1-4 CONTRACTOR (a f-S1 e (,0NSu1-7-1NL, PHONE CONTRACTOR ADDRESS1 . L, (30 SC 3�R 9 CITY/STATE/ZIP 2LO CK (R qS3 8l LICENSE ❑, C-42 ❑t IC-36 OTHER /!ZC E NUMBER 757¢79 EXPIRATION DATE (230I..Z/ W ER TABLE DEPTH: 3 7 ft GEOGRAPHICAL INFORMATION: Coordinates X Y PERC TEST # / BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION I ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ 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 /eft, DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ,r ❑ FILTER BED WIDTH ft LENGTH ft DEPTH DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE //�� ft ❑ MOUNDED WIDTH ft LENGTH ft DEPTH (+�,, 2mn DISTANCE TO NEAREST WELL ft FOUNDATION n PROPERTY LINE ft Ll SUMPS WIDTH ft LENGTH ft DEPTH �,�_ MEAi — �' DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE � A1?_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. M MfJM 48 H&MADVANCE NOTICE REQUIRED FOR INSPECTIONS -PLEASE CALL (209)p953-7697 SIGNED TITLE C/V/L DATE % / Ar -71 uk �j DEPARTMENT USE ONLY �l Application Accepted By G` Date /7� On'b Area v'� Employee ID#D Final Inspection By -, Date 2 O� ❑ SPECIAL PERMIT-Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Cha acter: COMMENTS 01 C" `'00 rc'ti LS• n O 2 PE SC Received Check#/ Amount Dat Permit/ Invoice# Permit ID# Code INFO B Cash Remitted Service Re ues # �iaa s-a3 �e �s i12a 42-01 /�/ ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18