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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 IVUNi[EI•UNUPJ5Lt rr.HMII "ALL LI/J Va.*-foul alum lNz0r&GIIVNJ CAYIKtJ I Tr.AK hKV1M LJAIt IJJUtI JOB ADDRESS i (r -05 CROSS STREET OWNER NAME OWNER ADDRESS Z O �/yI + � 1 1 4 I f �{vs`/`�� OM APN I i�L I//,�i +�• CITYI2NP 1. . 1"9- (/1 oq3 Py ` ,�J1 PA/vR�CELrySryI� /y�►A,51 ^p-PyH�O%NdE 1' /- 1/�1�'`C�) - 19,514 1 ► `�'`' ('L l CITYISTATNZifP� CONTRACTOR^A BQUhnf CONTRACTOR ADDRESS L- I Z S VV 1/,''+`^'f 1' aX C' L/ j C# VI I I f V i- , ". + f /y. rn/�,,^�C.,r4➢ PHONE -Q + �'1�}��C l(f e%%%y/IIIr! I �j�,( (0_CITYISTATEMP 1, / CL ff P d" CIO !' LICENSE C-42 C -N OTHER NUMBER I �ON ExPIRATioN DATE T HEREBY CERTIFY THAT HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAOU M COUNTY ORDINANCES, STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. AYMEr VT ECEIVED J 2020 DAQUIN COUNTY �' I-iE_ALTH DEPARTMENT Application Accepted jBy v Cl •�` Area / Employee ID# Final Inspection By, 1� Date u� . SPECIAL PERMIT -Approved by Character of Soil to Depth of 3 Pt: PWSump Soil Character: COMMENTS 1(,e DIC �rl��C. 0. c1a► a�T7o �=.klj� felwfe rn GL�encl ner,Nl�" ailelc/%% k,ih 1hIrc l."OkleQ1h I; nes C.C& e,71 S,(nGe 17FJ jej k cvoiG1hyitr.rePf stop( - to old <VtAe T.�hGs,r/onPc�anG*'ieo/�itFG'1—C-K `Milldado Code I INFO I i�// I ' I �,~V• I I -•• I Invoice# I PermitIDN h Remitted , SerJ a Request # Ips- DLJ �5 9 1v y�74 42-01 IT—.- ONSITE WASTEWATER TRTMNT SYSTEM PERMIT WATER TABLE DEPTH: 1 ft GEOGRAPHICAL INFORMATION: Coordinates X Y PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION REPAWADDITIoN ENGINEER DESIGNED (ALTERNATIVE REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: `RESIDENCE COMMERCIAL OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: 9' SEPTI TANK TYPEIMFG I CAPACRY � •I gal # OF COMPARTMENTS ❑ GREASE TRAP TYPEIMFG CAPACITY gal # of COMPARTMENTS DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft LFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) I `1O L LEACH LINES LEACHING CHAMBERS OF LINES ` LENGTH OF LINES ft ' \ I - <' DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY UNE ft ❑ FILTER BED Worn ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ MOUNDED Worn ft LENGTH It DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY UNE ft ❑ SUMPS Won+ It LENGTH ft DEPTH It DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE R ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH It DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft DISTANCE TO NEAREST WELL I `' : • R FOUNDATION It PROPERTY LINE It T HEREBY CERTIFY THAT HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAOU M COUNTY ORDINANCES, STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. AYMEr VT ECEIVED J 2020 DAQUIN COUNTY �' I-iE_ALTH DEPARTMENT Application Accepted jBy v Cl •�` Area / Employee ID# Final Inspection By, 1� Date u� . SPECIAL PERMIT -Approved by Character of Soil to Depth of 3 Pt: PWSump Soil Character: COMMENTS 1(,e DIC �rl��C. 0. c1a► a�T7o �=.klj� felwfe rn GL�encl ner,Nl�" ailelc/%% k,ih 1hIrc l."OkleQ1h I; nes C.C& e,71 S,(nGe 17FJ jej k cvoiG1hyitr.rePf stop( - to old <VtAe T.�hGs,r/onPc�anG*'ieo/�itFG'1—C-K `Milldado Code I INFO I i�// I ' I �,~V• I I -•• I Invoice# I PermitIDN h Remitted , SerJ a Request # Ips- DLJ �5 9 1v y�74 42-01 IT—.- ONSITE WASTEWATER TRTMNT SYSTEM PERMIT