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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 I5G► ( .S �'��J�3 CITY/ZIP � p CROSS STREET C�i i�.�wt. APN It J� �4O ^ �:S PARCEL SIZE c OWNER NAME CCI W Ca Y1 -3 PHONE OWNER ADDRESS -7 S- r ,�r:� / CITY/STATE/ZIP J L1C .+ �f5 CONTRACTOR (1 5 � v / "�lC��- ?�� ✓ PHONE CONTRACTOR ADDRESS P I'e] G�\ CITY/STATE/ZIP LICENSE DEC-42 111IC-36 OTHER NUMBER-�s EXPIRATION DATE j WATER TABLE DEPTH: Ian ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT# ),f-0051 LAND USE APPLICATION# TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: V6ESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: SEPTIC TANK TYPE/MFG elk-L- CAPACITY ?� gal #OF COMPARTMENTS(�- ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF S COMPARTMENTTS, DISTANCE TO NEAREST: WELL t; D� ft FOUNDATION z ft PROPERTY LINE Lot ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) I LEACH LINES LEACHING CHAMBERS ^ #OF LINES _ LENGTH OF LINES SIS ft y�� DISTANCE TO NEAREST WELL t,�J 1 ft FOUNDATION d j�ft PROPERTY LINE r�c'a r 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 Pr-"S,EEPAGE PITS NUMBER -3 WIDTH LIJ 11 ft DEPTH ��( ft DISTANCE TO NEAREST WELL ft FOUNDATION '7 S ft PROPERTY LINE n I 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 48 HOUR DVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 SIGNED TITLE DATE 5- �D a E Q , L O 114�p • 1.Y / DEPARTMENT U E ONLY Application Accepted B —�C�� Date II E 0,70 Area y�9 J Employee ID# A C rr Final Inspection By Date 6l Ae ❑ SPECIAL PERMIT-Approved by Character of Soil to Depth of 3 Ft: Pit/S mp Soil Character: COMMENTS Set-A:,tid fir j i - T,e r , tloi Se F/ ur P6o/d X10 �i- 1wr Q i 5 � I i PE Sc Received ec Amount Date Permit/ Invoice# Permit ID# Code INFO B ash Remitted Service Request# Lid 11 11-7 S8 II g •20 Sp. 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18