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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 209 953-7897 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS 45-0 7 S• Cr/�A-m Pft-LL- WE: • CITY/ZIP A1'dN IS-3 ZO Z' CROSS STREET KCNN�•Z�y APN P�AARCELSIZE -IS-3 ta{'�• Y OWNER NAME AL- GC&7rooj '-ea SDA p/jJ/pet�1PS LLL PHONE "Tec) -3+�--I OWNER ADDRESS , /0 �' u'rn�ytu r,y CITY/STATE/ZIP ESC H'W Nr C A 575370 CONTRACTOR L-!V`E OD AI& G-t�GN�II�On�H'1C'u�l'�t- PHONE 3�1- 3-7 q G CONTRACTOR ADDRESS 40-7 w• d fl- - ST• CITY/STATE/ZIP LICENSE E'..'.C-42 11C-36 OTHER CEG NUMBER -2'15-( EXPIRATION DATE WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y PERC TEST # 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: E RESIDENCE COMMERCIAL 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 O SAND OIL SEPARATOR(ENCLOSED SYSTEM) ❑ LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It ❑ SUMPS WIDTH ft LENGTH It DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ DISPOSAL PONDS WIDTH ft LENGTH It DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ 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. MALM140 HQU.R AM NCE NO TICEI EDF R INSPEC TIONS-PL EA SE CA L -7697 SIGNED TITLE 10d20• fV1b-'1Z. DATE It ` ��ZO -"M RUAD E i I 4ARC61.1 �I eo�AR�e Z VF® ic 4ft 20Z0 qT LONG TREE ROAD _.._ _—_ / V 1 OUN JY l CIyTgC DEPARTMENT USE ONLY Rr4fe Application Accepte y Date I r' Area y Employee ID# A 6 Final Inspection By Date ( SPECIAL PERMIT-Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS VI Q-4-.L- St. ,Q', P -S q,.-L Ic IF -poi-- G� S. q3 I'Y► n a- y PE SC Received Amount Date Permit/ Invoice# Permit ID# Code INFO By Cash Remitted Service Request# 4-1 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18