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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 J O � �O (�/ CITY/ZIPq"GAa C ) 1 CROSS STREET r(�dVe fG{L.{C.l/� APN O Q:2d�7 6 PARCEL SIZE OWNER NAME �� /-�► J 1 J �p�Lt}�, 9 , I PHHO/NIE- ( v OWNER ADDRESS Po Fb�X )5-70 CITY/STATE/ZIP Or of;�� e qJ s� CONTRACTOR C �// PHONE orW�'o Cf - CONTRACTOR ADDRESS G P //( ivU� CITY/STATE/ZIP LICENSE ❑YC-42 ❑LJC-36 OTHER NUMBER yS�la�S' EXPIRATION DATE WATER TABLE DEPTH: ' v J ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: _ NEW INSTALLATION REPAIRIADDITION ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM I DESTRUCTION INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: 3 NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPE/MFG ��/SSS CAPACITY gal #OF COMPARTMENTS ❑ 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) LEACH LINES 1-1 LEACHING CHAMBERS #OF LINES y / LENGTH OF LINES 7�O ft s DISTANCE TO NEAREST WELLft FOUNDATION ® ` ft PROPERTY LINE l�� / 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 1 SEEPAGE PITS NUMBER ) WIDTH 3 ' ft DEPTH DISTANCE TO NEAREST WELL /�d , 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 ORDINANCES, STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. MINIMUM 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 SIGNED T /!/ TITLE DATE 12 — ` C;V 1 04k DEPARTMENT USE ONLY %QTc UN Application Accepted By V Date O Area y ? Em,.-, Final Inspection By—V, �� ( it T Date 2 E SPECIAL PERMIT-Approved by r Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS SJ&tern fGll '/I)tG. l�rr /�p ,Jel'15 �qn reczrrjs PE SC Received h #/ Amount Date Permit/ Invoice# Permit ID# Code INFO B Cash Remitted Service Request# �� 1� IIs 2 #3�a Z' w i�L(Sc��Z �{ 42-C1 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18