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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 6884 Nassano Rd. CIrr/LP Stockton 95212 y r � CROSS STREET E Hildreth Lane APN- OR s a C)3 i a PARCEL SIZE r✓ 0 OWNER NAME Dawn Souza PHONE 203688-7009 OWNER ADDRESS 8884 Nassano Rd. CITY/STATE/LP Stockton CA 95212 CONTRACTOR Stormwater Services PHONE 916203.6259 CONTRACTOR ADDRESS PO BOX 569 CITY/STATEZP Wilton CA 95693 LICENSE Ll C-42 L C36 OTHER NUMBER 1012047 EXPIRATION DATE 03-31-2022 WATER TABLE DEPTH:50 ft GEOGRAPHICAL INFORMATION: Coordinates X Y J PERC TEST # BUILDING PERMIT# E LAND USE APPLICATION# TYPE OF WORK: NEW INSTALLATION REPAIR/ADDmON ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: LI RESIDENCE J COMMERCIAL OTHER NUMBER OF LIVING UNITS:N/A NUMBER OF BEDROOMS:4 NUMBER OF EMPLOYEES:WA ❑ SEPTIC TANK TYPEIMFG CAPACITY gal #OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS DISTANCE TO NEAREST: WELL ft FOUNDATION it PROPERTY LINE ft ❑ LIFTSTATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) LEACH LINES LEACHING CHAMBERS 1 #OF LINES 1 LENGTH OF LINES, ft DISTANCE TONEAREST WELL ft FOUNDATION It PROPERTY LINE It ❑ FILTER BED WIDTH it LENGTH ft DEPTH It DISTANCE TO NEAREST WELL it FOUNDATION ft PROPERTY LINE ft ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY UNE It ❑ SUMPS WIDTH R LENGTH ft DEPTH DISTANCE TO NEAREST WELLft FOUNDATION ft PROPERTY UNE ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH n�/V�� DISTANCE TO NEAREST WELLft R V FOUNDATION ft PROPERTY LINE SEEPAGE PITS NUMBER 1 WIDTH 3.5 ft DEPTH 25 O D DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY OR �D?O STATE LAWS AND RULES AND REGULATIONS OF AN MINIMUM 48 HQUR ADVANCE NOTICE REQUIRED FOR/NSP T ONS COUNTY. P A A L q l SIGNED 5 V/ TITLE DATE S —/ � L Rr4 41T * D EP T I NT29 QNL Y Application Accepted.. Date S Z 0 Area Employee ID# / _ Final Inspection BytUADate U SPE IAL PERMIT-Approved by Character of Soil t 10 o 3 Pi ump Soil Character. LL L L"� I COMMENTS 4 116 JF oY1 �Irx�yn i+ Yl <FR ansh'nz S E7 S`'�?G PE SC Received Chack#/ Amount Date PenMtl invoice# Permit ID# Code INFO B sh Remitted :Service R uest# r.1 1 a 115 S 8L S 4ONSITE WASTEWATER TRTMNT SYSTEM PERMIT1/14//141 18