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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 10390 N . s 1 L v im C"S`` b9- CITY/ZIP 5,��i�TQ I� {.S it Z y CROSS STREET "3LNC4 OAk APN�DB(a-f —2 PARCEL PARCEL SIZE 1.Cl A ' p OWNER NAME SD«N K'1 c/or"�1C"#-j AIWO� PHONE(91(y) '-�4q- 132.3 C p V OWNER ADDRESS 2,7r� *r>6V&LLS �L'�D` `� �O� CITY/STATE21P P-0SCVILLt,CA { Lob( CONTRACTOR LIVE OA-4GE,QEN VIt�CNM'�thL PHONE 36 1_o-5-1S' CONTRACTOR ADDRESS (7 S T-• CITY/STATE/ZIP 1^O. )l C'A LICENSE U I...'C-42 OIC-36 OTHER Cee— NUMBER Z I S 1 EXPIRATION DATE ..-j V Z Z WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y PERC TEST I BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ,_ ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: 0 RESIDENCE -1 COMMERCIAL E OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPE/MFG 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 LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE 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 O SEEPAGE PITS NUMBER WIDTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft 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 SAN JOAQUIN COUNTY. ENOTICE ED FOR INSPECTIONS p PLEASEALL(209)953-7697 SIGNED 4 TITLE DATE `9 Z� Fc MFNT , p �/VF® 10 2020 QVIN CO FPgR.4tY DEPARTMEN USE ONL Y 11 Application Accepted jay Date X0,10 Area '1 —/ Employee ID# L Final Inspection By Date 020 SPECIAL PERMIT-Approved by Character of SOH Depth of 3 Ft: Pi ump S character: COMMENTS�A 'D& (2. o2., 025 M-,III i rl L UTT PE SC Received Amount Permit/ Code INFO B Cash — - Date Service Request# Invoice# Permit ID# sa3 ILS � 15,2.�s 10 74 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18