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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 186E E.HAZELTON AVENUE-STOCKTON CA 96205-(209)468.1420 NON-REFUNDABLE PERMIT CALL 209 953-7897 FOR INSPECTIONS EXP.IR7ES 1 YEAR FROM DATE ISSUED JOB ADDRESS �j f' C.+ jITTYIZIP 7 14-r" C lr- CROSS STREET L< f.Vl� 47 APN 003 IIA 1 /_> PARCEL SIZE I p OWNER NAME �o SIPp L G er PHONE OWNER ADDRESS ,SIn,ro-e C1TY/STATE/ZP CONTRACTOR C".11',1/ JP14L PONE _ CONTRACTOR ADDRESS 3 ,7 AA r P. CETYISTATFJZIP LICENSE /,(C-42 C-36 OTNa NUMBER Y5 `I j EXPIRATION DATE WATER TABLE DEPTH:.,? y C) R GEOGRAPHICAL INFORMATION: Coordinates X Y F77PERC TEST X BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: NEW INSTALLATION REPAIR/ADDmcN ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: RESIDENCE COMMERCIAL OTHER NUMBER OF WING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPE/MFG �X/SH '% CAPACITY gal #OF COMPARTMENTS ❑ GREASETRAP TYPE/MFG CAPACITY gal #OFCOMPARTMENTS DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP O PKG TX PLANT O SAND OIL SEPARATOR(ENCLOSED SYSTEM) LEACH LINES{3 ) LEACHING CHAMBERS #OF LINES _ LENGTH OF LINES ' ft C DISTANCE TO NEAREST WELL I ft FOUNDATION -3 6 ft PROPERTY LINE �� ft ❑ FILTER BED WIDTH It LENGTH ft DEPTH ft DISTANCE TO NEAREST WELLft FOUNDATION ft PROPERTY LINE ft ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY UNE ft SUMPS&) WIDTH � � ft LENGTH �6R/ J ft DEPTH �f'� ft DISTANCE TO NEAREST WELL / CG' ft FOUNDATION ft PROPERTY UNE ft ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft SEEPAGE PITS NUMBER WIDTH ft DEPTH _ _ft r DSTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE 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 SS/AN JOAQUIN COUNTY. MINIMUM48H URADVANCE14 OR INSPECTIONS-PLEASE CALL(209)953-7697 SIGNED 7 TITLE (_G'I�i/+�i�� DATE + MFNr ?020 DEPARTMENONLY pqR A14 `r Application Accepted By Data 11 / O.,ZO Area Employee ID# TMFN� Final Inspection By 50 3A4 Date IUVI ZQ td L SPECIAL PERMIT-Approved by Character of Soil to 046 Of 3 R PklEunp SON Character. COMMENTS 5 rur P--// o SW�NY�IN 879 e Q05 W, } lin e r A &s. PE SC Rep A—MntPorn"Code INFO Cash Rem Service nestle Invoke# Permit ID# 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18