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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 'I YEAR FROM DATE ISSUED QO Gad' lam¢ JOB ADDRESS Se 4h CITY/ZIP i m CROSS STREET t/, �_ L APN�,1133aa PARCEL SIZE �� p l/' V OWNER NAME Vt&t /-(�•rW� PHONE s v: OWNER ADDRESS /-SG1014'f CITY/STATE/ZIP '//, CONTRACTOR GCS/n (fV ( PHONE -,20 34,1; ---Lid 7C� L� CONTRACTOR ADDRESS �/ /� > fCLM ��/!IW (/ U�CITY/STATEIZIP J(yc kA-1 64- / �� / LICENSE ❑?C-42 ❑:JC-36 OTHER NUMBER / r, EXPIRATION DATE WATER TABLE DEPTH: !'1/ ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: I NEW INSTALLATION I.i REPAIR/ADDITION ENGINEER DESIGNED ALTER ATIV�, REPLACEMENT #L1MkIe"k C4 I OUT-OF-SERVICE SEPTIC SYSTEM i( DESTRUCTION L INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ElOTHER NUMBER OF LIVING UNITS: _� NUMB ER OF BEDROOMS: 3 ) NUMBER OF EMPLOYEES: SEPTIC TANK TYPE/MFG L' — CAPACITY 16100 gal #OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS DISTANCE TO NEAREST: WELL_/� O ' ft FOUNDATION CPO ft PROPERTY LINE 'PO ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) ,W LEACH LINES i' LEACHING CHAMBERS #OF LINES_ 7 LENGTH OF LINES 8S ' ft ` DISTANCE TO NEAREST WELL_ 13th i ft FOUNDATION 3 y 1 ft PROPERTY LINE 951d r 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 WIDTH L je8 to ft DEPTH ft DISTANCE TO NEAREST WELL aQ0 'T ft FOUNDATION llO ft PROPERTY LINE ��7 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. MINIMUM 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS- PLEASE CALL 209 953-7697 SIGNED TITLE �OAITGt'�^ DATE DEPARTMENT USE ONLY /1 Application Accepted B `- /-��1� Date �t7�?u Area Employee ID# DFS Final Inspection By ` Date I 2 �7-0 ❑ SPECIAL PERMIT-Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS Fa i vie I syslero. T,'er ff No wells o s beicks et rpurfvr s 11 V -�✓I rQi � 4 rC� r'�r- a PE SC Received heck#/ Amount Date Permit/ Invoice# Permit ID# Code INFO B j Cash Remitted Service Request# y011 Is W2 300 10 21 Z� S R Oo 8�1 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18