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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 JOBADDRESS �^&9 '37Ga,,�-A TDk,,i(,l CITY/ZIP_.LOgCZgo CROSS STREET t1�1(iGt�`�I�ONL1J APN b6 3d 1 �7 ,.PARCEL SIZE 9r l OWNER NAME UM VCCT �CS�C.k PHONE_ OWNER ADDRESS �Jd+N`J`a, CITY/STATE/}ZIIPq�y 0 �( CONTRACTOR �C0�l ��f;I�12i 1A7�1 �I�l, PHONE �I q 6-1/Z! �}, CONTRACTOR ADDRESS I �I�LJO��(S CITY/STATE/ZIP j rpt�q CA '7 go/J El: ❑ LICENSE . C-42 CIC-36 OTHER 1S NUMBER SN 2`y 1 EXPIRATION DATE WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT# ' 3'-I LAND USE APPLICATION#I TYPE OF WORK: J NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED I LTERNATIVE REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL 7 Pyr El OTHER NUMBER OF LIVING UNITS: n t NUMBER OF BEDROOMS: O� r NUMBER OF EMPLOYEES: SEPTIC TANK TYPE/MFG Y 4i l- ( CJ�C-Y`e,4<— CAPACITY 2UQU gal #OF COMPARTMENTS 2 ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS DISTANCE TO NEAREST: WELL IDU t ft FOUNDATION /C-) ft PROPERTY LINE ,C) e ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) LEACH LINES tiI LEACHING CHAMBERS 3LP #OF LINES _ LENGTH OF LINES //,,J1 ft DISTANCE TO NEAREST WELL ft FOUNDATION /v T ft PROPERTY LINE Xy 7 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 17 WIDTH it ft DEPTH S r ft DISTANCE TO NEAREST WELL / 0';�- ft FOUNDATION 49 t ft PROPERTY LINE /,o 4— 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. MINIM4.1M 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONSPLEASE CALL 209 953-7697 SIGNED TITLE C64A-CLCLIV- DATE n J DEPARTMENT USE ONLY 1� Application Accepted By_ Date J Jib Area Employ �D Final Inspection By Date � �� G�'� C SPECIAL PERMIT-Appop Character of Soil to Dep O' t: Pit/Sump Soil Character: COMMENTS S Pi V! re. r ar la as do S sft,f r w;11 be kje,.%/ ` C s Stem R, SQca, Ie. - Am' ,er fed nbzboaw Crory. ✓ 2n7n rep( i r 4-v y)e r4 sks�rN 'f2 _y V�R�V o>J, PE SC Received Amount Date Permit/ Invoice# 'qRj # Code INFO By Cash Remitted Service Request# 3 l 92 �� a�� Z -S 'ds outtl 2 F 42-01 C( �(1 � I I Q ^ , 0 ONSITE WASTEWAT TMNTSY-4EaVMIT 4/14/18 v �1�1 �U� u y z �OQUINCO �V e9LTy P At �HTPy