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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONME ENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 NON-REFUNDABLE PERMIT 1 CA L(209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS 'Z7 CITY/ZIP 'IAA n k ce, GA q566 Ar y CROSS STREET %V ROYT APN 1004 PARCELS17E I C OWNER NAME LAIC— IV PHONE 4LO OWNER ADDRESS`, 1 O I 1�11•r-,N pi",,,ti rrK'� PG CITY/STATE/ZIP J S%)A r1 t/v CP ':' m CONTRACTOR y. acc .�� PHONE / �• w �L I CONTRACTOR ADDRESS sc s Aefl 1 L wh CITY/STATE/ZIP TMGCY CA LICENSE ❑-7C-42 OC-36 OTHER NUMBER no qj2 EXPIRATION DATE /� + WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST #_ BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: NEW INSTALLATIONr �' REPAIR/ADDITION _ ENGINEER DESIGNED/ALTERNATIVE X. REPLACEMENT (ehLA P)t _ OUT-OF-SERVICE SEPTIC SYSTEM _ DESTRUCTION Piex INSTALLATION WILL SERVE: K RESIDENCE ❑ COMMERCIAL El OTHER I NUMBER OF LIVING UNITS: 7— NUMBER OF BEDROOMS: #^ NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPE/MFG `/� I�J 7 J nG CAPACITY I O d gal #OF COMPARTMENTS C ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft ❑ LIFTSTATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) LEACH LINES LEACHING CHAMBERS_ #OF LINES_ _ LENGTH OF LINES it DISTANCE To NEAREST WELL I FOUNDATION it PROPER`TYLINE it ❑ FILTERBED WIDTHLiL ft LENG H `7✓ / ft DEPTH �J / ft DISTANCE TO NEAREST WELL �d ft FOUNDATION- ft PROPERTY LINE, ft ❑ MOUNDED WIDTH ft LENGTH ft DEPTH it DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE It ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ DISPOSAL PONDS WIDTH fl LENGTH ft DEPTH ft DISTANCE To NEAREST WELL It 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. MWIM&b 48 HOWt;0AN99 NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 SIGNE TITLFLf�Jll�- DATE L'/ - L� 'yMENT CEIVE® B 0 1 2021 OAQUIN COUNTY IRONMENTAL AT H DEPARTMENT / DEPARTMEN U EONLY Application Accepted By Date I C Area j Employee ID# Final Inspection By Date Z 1 5 I--Z-�1 ❑ SPECIAL PERMIT-Approved by Character of Soil to epth 06 Ft: Pit/Sump Soil Ch racter: COMMENTS a I � Ly c - I !fit SM.Q IFY f P PE SCReceiv d Check#/ Amount Date Permit] Invoice# Permit ID# q Code INFO as Remitted Service Re uest# a1L 11,5' 00 t 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4114/18