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l % ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 NON-REFUNDABLE PERMIT GALL ZUY) Yb3-/6'J/ FOR INSPECTIONS tXPIRES 9 TEAR FROM DATE ISSUEI JOB ADDRESS (iU CITY/ZIP CROSS STREET _l� &14 S � 7 APN D 003 PARCEL SIZE OWNER NAME„&V e TYJIai_ PHONE % [� OVL OWNER ADDRESS q6 IG ' CDy90 ��/ �� CITY/STATE/ZIP b4by), N I /J CONTRACTOR t C, "z 1_ PHONE 369— CONTRACTOR ADDRESS J �7 OiJ,Z J�G/V z Il CITY/STATE/ZIP LICENSE LI/G-42 ❑rlC-36 OTHER NUMBER ysyvL%EXPIRATION WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION Y, REPAIR/ADDITION ENGINEER DESK REPLACEMENT I OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION TERNATIVE INSTALLATION WILL SERVE: ❑ RESIDENCE k COMMERCIAL ❑ OTHEROJ_6119 hQkre GJr' SOuNI , NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ SEPTIC TANK ❑ GREASE TRAP ❑ LIFT STATION TYPE/MFG CAPACITY TYPE/MFG ' CAPACITY DISTANCE TO NEAREST: WELL ft FOUNDATION _ SIZE TYPE OF PUMP ❑ PKG TX PLANT gal # OF COMPARTMENTS gal # OF COMPARTMENTS ft PROPERTY LINE ft ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) 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. SIGNED��u• Ke � � DATE T i z m 7 DEPARTMENT U E ONLY /� Application Accepted � L� Date r' ,DO Area C� Employee ID# DA �..—' Final Inspection By Date g7o � SPECIAL PERMIT -Approved by Character of Soil to Depth of 3 Fr_ jPjit/Surn Soil C aracter: COMMENTS F,-,) lu, e aC sysjeW , MA;)e hoi'►'/t' tYirK 5 Pc-�ia Per,.O - NO qo” Ilre'Inc) 5 c4f- 3S� c-)eeD. fYiofe c)e�c ileo mQp *D bP plav)c�ed PE Code Sc INFO Received B Check#/ as Amount - Remitted Dat IJA ❑ LEACH LINES LEACHING CHAMBERS yd Is- # OF LINES LENGTH OF LINES , ft -FSS"I DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LININ E V ft ❑ FILTER BED WIDTH ft LENGTH ft DEPTHfill —40 ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LIN ft ❑ MOUNDED WIDTH ft LENGTH ft DEPTH SAND �ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPEF RRg ft E3 SUMPS WIDTH ft LENGTH ft DEPTH FPARTME ,,. 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 70 WIDTH S ft DEPTH 3S' ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE 7 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. SIGNED��u• Ke � � DATE T i z m 7 DEPARTMENT U E ONLY /� Application Accepted � L� Date r' ,DO Area C� Employee ID# DA �..—' Final Inspection By Date g7o � SPECIAL PERMIT -Approved by Character of Soil to Depth of 3 Fr_ jPjit/Surn Soil C aracter: COMMENTS F,-,) lu, e aC sysjeW , MA;)e hoi'►'/t' tYirK 5 Pc-�ia Per,.O - NO qo” Ilre'Inc) 5 c4f- 3S� c-)eeD. fYiofe c)e�c ileo mQp *D bP plav)c�ed PE Code Sc INFO Received B Check#/ as Amount - Remitted Dat Permit/ Service Reguest # Invoice # Permit ID# yd Is- 195-1 2 9/o -FSS"I 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18