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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 L y IC'/i') Rn CITY/ZIP M-Cdi.sCvr e& 495:3xa L/' n/� y CROSS STREET Ao ' '11 n P APN , 00-7 7 O 0(0 PARCEL SIZE �' 1 0 0 C OWNER NAME C,5�51f'zZG (Zapf PHONE-., �(, PHONE ~Z�-" CW I�( � OWNER ADDRESS I so c t W G♦1 /'y CITY/STATE/ZIP 1G,1 (A q S 33 S CONTRACTOR 1S CSC ;y�- �P j PHONE �" a�Yfo S 7 CONTRACTOR ADDRESS CITY/STATE/ZIP. G'/LQ`�i LICENSE ❑0C-42 ❑0C-36 OTHER NUMBER °- EXPIRATION DATE s1 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 i--I OUT-OF-SERVICE SEPTIC SYSTEM ❑ DESTRUCTION INSTALLATION VVILL SERVE: P-<ESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: J 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 ` LI ft DEPTH g It ft DISTANCE TO NEAREST WELL 10MI ft FOUNDATION 1 ft PROPERTY LINE J I 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 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. MINIMUM 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209)953-7697 SIGNED l ? TITLE Cot,A)�et_j,r DATE 3 1 �/l T or H T DEPA R TMENT USS ONLY Application Accepted Be 5eV Date Area Employee ID# Dr r c, Final Inspection By J Date-a,;/?, 7,6 Z4 ❑ SPECIAL PERMIT-Approved by Character of Soil to Depth of 3 D' l �� Pit/Sump Soil Character: N COMMENTS RQ c1115 Or 1Ac "7 1h F) ,�✓ ne_-1e1'PyMjnr- ve alr. tj 6 ,J e 11!5 w ,4hr m 1„�'w►v m c P a�k o — Tr <e42Ic �-f a /PG0! PE SC Received hec Amount Date Permit/ Invoice# Permit ID# Code INFO B as Remitted Service Request# 14310 FIs 18' Seo 3 S 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18