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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 E.xPPIAREpS 1 YEAR FROM DATE ISSUED JOB ADDRESS �`],() �, D G SP1= CITY/ZIP CROSS STREET , x`�E� i �T APN � [�L (��Q� PARCEL SIZE OWNER NAME ��►S Fe yj /1 PHONE� OWNER ADDRESS _wJ� S `� CITY/STATE/ZIP L�� (_��•�'-' �s Jam`^ � n p CONTRACTOR S\E��A(ZJ,l�cT G-Z��S� yC�10r�1 {� SI.�TLC_ PHONE �Q �Zl9, CONTRACTOR ADDRESS ' SSV l9-� � �7'��Q� CITY/STATE/ZIP LICENSE A,..Q-42 ❑1 IC-36 OTHER NUMBER V-�c�SS EXPIRATION DATE WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y E PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: NEW INSTALLATION t REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT J-&ACA4 Lto tLS OUT-OF-SERVICE SEPTIC SYSTEM I! DESTRUCTION INSTALLATION WILL SERVE: RESIDENCE C COMMERCIAL C OTHER NUMBER OF LIVING UNITS: Vn 1�. NUMBER OF BEDROOMS: 13 NUMBER OF EMPLOYEES: 'Gy— ❑ SEPTIC TANK TYPE/MFG E x�`3T1�.1 CAPACITY gal #OF COMPARTMENTS �i- ❑ 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) XLEACH LINES K LEACHING CHAMBERS 214 #OF LINES .3 LENGTH OF LINES 'Ta ft DISTANCE TO NEAREST WELL 100 4 ft FOUNDATION ft PROPERTY LINE ;5 •'1— 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 3 WIDTH 1l 81 ft DEPTH 25 ' 1 ft DISTANCE TO NEAREST WELL I }- f'` FOUNDATION ID + ft PROPERTY LINE v� '� 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 DVANC NOWICE REQUIRED FOR INSPECTIONS -PLEASE CALL 209 953-7697 SIGNED TITLE (f1!x -tCrb'1 DATE 207-0 ho V 0 40 020 4 o 0 T�N7Y 1 T DEPARTMENT USE ONLY n Application Accepted By Date lis- USO Area v� �C� Employee ID# DA r-- Final Inspection By , Date . E SPECIAL PERMIT-Approved by Character of Soil to Depth of 3 Ft: Pit/ ump Soil Character: COMMENTS 6gI1v/P CX►sbi% ]or erne/ exit-Ax tys: Fep" oid lines •y bC- o4et/16,1oAca 3( 4 0�y��Y 1P he ronn�er•f� t- 5etil&f f nP14 reoC;/K or S'Awer: Ore 4koe F.re;n�otl�� ,pvlelP �./Ue tv e-4"0 b-1 (- 31an ub]l1 er r�� L rPct�r �e 4tii�cLrr(n PE SC Received <Aheck Amount Permit/ Code INFO B as Remitted Date Service Request# Invoice# Permit ID# 910 l s 03-7 �3v0 t 2D t 11 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18