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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 LCALL 209 953-7697 FOR INSPECTIONS �y EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS (i I"Y 1 I C CIN/ZIP � ` 70PARCEL SIZE STREET � 7q /1230 APN �X� �� m c OWNER NAME Vv�0.j' 0� r'\�I✓�-�-�- �+� W•\Ji Tt�-��f-' PHONE 2v\ n - io / OWNERADDRESS l.Yl 4� �D.D 1'�JG L' �L' CITYISTAT ISP �yZ 'T�C�J CF' C77ZI y CONTRACTOR �Ba,-,CCA< �+y5�Y1-�, T'1 J�� PHON 16f-&>-K,-vi-, , 'f-Z� /7��j� CONTRACTOR ADDRESS -I 1 c++•I I b��~�� CITY/STATE/ZIP e-7'R�Z-'K�/v i)i CA LICENSE ❑7C-42 ❑-C-36 OTHER 11 " NUMBER_7d EXPIRATION DATE 11 f 3- u WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: _ NEW INSTALLATION _ REPAIR/ADDITION _ ENGINEER DESI NFD/14�TERNATIVE REPLACEMENT _ OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION (`GN INSTALLATIONWILLSERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: 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 R ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) ❑ LEACH LINES C LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ MOUNDED WIDTH ft LENGTH ft DEPTH It DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE R ❑ SUMPS WIDTH It LENGTH ft DEPTH it 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 R ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH It DISTANCE TO NEAREST WELL it FOUNDATION it 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. 1 8 HOUR AdANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697. SIGNED TITLEI - DATE-,?,1!2 17,1 loll MFNT gm I �VFD z0z� NTV Nn' AC DEPARTMENT USE ONLY ` T Application Accepte By. 1l v Date Area C7 C� Employee ID#_r-)A Final Inspection By Date Z/ & /L 1 ❑ SPECIAL PERMIT-Approved by Character of Soil to Depth of 3 Ft: PitISump Soil Character: ab COMMENTS 'I.khA4 -Jin bV 1-ew01& E,14/LIe t � 6 �.✓li1 t7U�/� (,c-SPI' kc-P' PE SC Received hec Amount Date Permit/ Invoice# PermitID# Code INFO By ash Remitted Service Request# ZI.?a 0 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4114/18