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' ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468.9420 NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED -2-2-4C> . mJOB ADDRESS CROSS STRdET 1C D►fn APN oas OWNER NAME k�\a )n 1"Otbt! N e-, PHONE.2 '✓��l 1� V OWNER ADDRESS\A,_.LJ�11 IK. /a-1�7,, t0XA'\(V�`1,�, �p CITYISTATE/LP�/' '�/' wy ` CONTRACTOR VVC kZ�1�.,YnA.� fid xL:4gC�(,'l PHONE ?-OCI 1. ';5 J�.�`� � (� 1V CONTRACTOR ADDRESS 'J'J 1"`UVB/VVL-1\ .'T� - Crry/STATE/LP x,,d i 1 1„ A ts�'fO N LICENSE �..l C42 ❑ C-36 OTHER �/ NUMBER�CS115`l EXPIRATION DATE 2-02-3 WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y PERC TEST # BUILDING PERMIT#9rL� LAND USE APPLICATION# TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT OUT-OFSERVICE SEPTIC SYSTEM DESTRUCTION 1 II INSTALLATION WILL SERVE: -bE110E COMMERCIAL OTHER FV r»I USE G NUMBER OF LIVING UNITS: ,{ NUMBER OF BEDROOMS: /.��^� NUMBER OF EMPLOYE S: SEPTIC TANK TYPE/MFG ZI CAPACITY `Z�/\/ gal #OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS DISTANCE TO NEAREST: WELL 1 W ft FOUNDATION J ft PROPERTY LINE t ft ❑ LIFT STATION SIZE TYPE OF PUMP O PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) LEACH LINES LEACHING CHAMBERS #OF LINES 2— LENGTH OF LINES DISTANCE To NEAREST WELL JUD_ft FOUNDATION-_ft PROPERTY LINE ❑ FILTER BED WIDTH it LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE R ❑ MOUNDED WIDTH R LENGTH ft DEPTH fl DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY UNE ft ❑ SUMPS WIDTH It LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY UNE ft ❑ DISPOSAL PONDS WIDTH ft LENGTH it DEPTH ft DISTANCE TO NEAREST WELL it FOUNDATION ft PROPERTY LINE ft ❑ SEEPAGE PITS NUMBER WIDTH it DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE R 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. 48 HOUR ADVANCE NOTICE9 5 - SIGNED TITLE ni�G Y Y DATE I� 1J O JL I Vi I DEPARTMENT US ONLY i4r, Application Accepted By Date 6 ,9 a 30 Area � Employee ID# *-•�N� Final Inspection By Date -Z= J SPECIAL PERMIT-Approved by Aq Character of Soil to Depth of 3 Ft: PIVSump Soil Character: COMMENTS Ne,.) S y54(-ro (dor AG bc ,ldioq, AA E9 RD /NCpj T_ PE Sc Received heck#/ Amount Data PermIV Invoice# Permit ID# Code INFO B Remitted Service t I �MEHT Lb I LI7Zlo. 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18