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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 LL(209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS I C' lO`-"-' r b /ZI CITYP CAG/ y CROSS STREET /G rr�'� '}�Zt I APN 6 la 3 b PARCEL SIZE o 0 SII S O OWNER NAME PHONE// C 11--�� OWNER ADDRESS A-J36 5c4i—LCI'A CITY/S TATE/Z7IP�r� 1 LLCG-� CA CONTRACTOR , PHONE V.J l �LC4, CONTRACTOR ADDRESS �U�GIJ N'1KNJ�b� gJ `! CITY/STATE/ZIP I •'wV LICENSE I� C-42 LJ/ C�-36 OTHER NUMBER 1q q z J 1 EXPIRATION DATE �—Z I WATER TABLE DEPTH: 110-3fk�41 �J ft GEOGRAPHICAL INFORMATION: Coordinates X Y I- PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE ?C REPLACEMENT L24, ' OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: X RESIDENCE L COMMERCIEIL /MI [ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: I r, ""�L"� NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS DISTANCE TO NEAREST: WELL It FOUNDATION It PROPERTY LINE R ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) ❑ LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft DISTANCE TO NEAREST WELL It_ FOUNDATION ft PRIW;LINE ft id FILTER BED WIDTH ,0T7 ft LENGTH t ft DEPTH MI it DISTANCE TO NEAREST WELL P.L'6I,c ft FOUNDATION I�Iij -i'* It PROPERTY LINE 19 UJ fl ❑ MOUNDED WIDTH ft LENGTH It DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY UNE ft ❑ SUMPS WIDTH ft LENGTH It DEPTH fl DISTANCE TO NEAREST WELL It FOUNDATION fl PROPERTY LINE fl ❑ DISPOSAL PONDS WIDTH It LENGTH ft DEPTH fl DISTANCE TO NEAREST WELL ft FOUNDATION fl PROPERTY LINE fl ❑ SEEPAGE PITS NUMBER WIDTH R DEPTH fl DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE fl 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. MINIMLAt48 HOUR ADVANCE F -PLEASE L 2 �,y 7 SIGNED TITLE f`'ry^ DATE .Z 2Z VZv Nr E� 020 UNPY —_gig H+ / DEPARTMENT USE.ONLY ANT Application Accepted By Date J3 Area Employee ID# Final Inspection By ( Date Com\ f 0 h�-1-01A C SPECIAL PERMIT-Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS F , fe t4 tech IC ivi ' fl»rS n 41 c . 5 E-l' V tL r"�t4— S-1. LQ— CCS PE SC Received Chec Amount Date Permit Invoice# Permit ID# Code INFO By ash Remitted Service Request# 0 15 430.0 2 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14!18