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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1666 E.HAZELTON AVENUE-STOCKTON CA 95205.(209)466.3420 NON-REFUNDABLE PERMIT CALL 2TL R0-9 953-7697 FOR INSPECTIONS r EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS 19152- F 15r— r_. CQ CITYIZIP G S C.a 10 14 I r CROSS STREET `�L ✓� APN ad73 D13 PARCEL SIZE /' /]'7 G p OWNER NAME fL AhG i� Ra ke- PHONE 2,007-l! 4- 't ICS z 8 OWNER ADDRESS 39z 4.4(. VS 1/I^. CITY/STATE/ZIP �I'� ►'/I CJ(�(lJr� CONTRACTOR [ /V\)YI?'-r PHONE CONTRACTOR ADDRESS CITY/STATE/ZIP LICENSE Ll C42 ❑! C-36 OTHER 7[ ) NUMBER EXPIRATION DATE WATER TABLE DEPTH: 7"'—�1" ft GEOGRAPHICAL INFORMATION: Coordinates X Y G PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: A NEW INSTALLATION REPAIR/ADOITION ENGINEER DESIGNED IALTERNATIVE REPLACEMENT OUT-0F-SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: G RESIDENCE G COMMERCIAL YN OTHER O• )h '" CCMS NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: zSEPTIC TANK TYPE/MFG ` 0h C:Y CAPACITY l2U U gal #OF COMPARTMENTS ❑ GREASETRAP TYPE/MFG � CAPACITY gal #OFCOMPARTMENTS DISTANCE TO NEAREST: WELL 'jD S &e+it FOUNDATION ft PROPERTY LINE_5ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) 13 LEACH LINES LEACHING CHAMBERS #OF LINES 2 7 LENGTH OF LINES U It DISTANCE TO NEAREST WELL It FOUNDATION a ft PROPERTY LINE ft ❑ FILTER BED WIDTH It LENGTH ft DEPTH it DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ SUMPS WIDTH ft LENGTH ft DEPTH It DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ DISPOSAL PONDS WIDTH it 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 PR PARED 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. MI I -DVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 7 SIGNED TITLE W KEN DATE 12-1-2 c'L6 I IL 1111 H TNIE DEPARTMENT USE ONLY /I Application Accepted By rTTzl Date 1,1131 Od0 Area L4 C1 6) Employee ID# Q.S Final Inspection By (2Q&,{2Chn_�&M jp4 ,d, Date U, t-LO'L� SPECIAL PERMIT-Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS S_Co)/G/St' die sy54vk, onr, Lel. Fa, /+ b,,0117t' tkI YZI'WI NO Wells l.I J} ;V) SCIL(kS Of- C4D /pca(dS, r�.a, e�e ts• oma. <1os� c�R�e�r��— R�� t� L..L PE tINFO Received Check#/ Amount Date PermlU Invoice# Permit ID# Code B Cash Remitted Service R uest#III 4:5Y9 112-1311 9260BN5 42-01 d�-.Qr/� 1� -`�F" Off,.L� I�0-�� 1 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18 ` ` ,_J•�