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i 2 Pw` ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 NON-REFUNDABLE PERMIT GALLZU,9Y0J-/0`J/ FOR 1N5PEG11UN5 CAVIKLJ 1 I rAK i-KVIYI LJNI C IJJUCI JOB ADDRESS g • I?C / e v- CITY/ZIP C` CROSS STREET /APIN {jv�y PARCEL SIZE 1 I J OWNER NAME 1 �'/ o c -C Al t��C� p r ?M- �' PHONE OWNER ADDRESS s` y"iN ! //�,, ///� CITY/STATE/ZIP 26, /� �7y /� CONTRACTOR 1/N7' Gil 37q& I( /U� / �':�C PHONE ��'1 7�^J�/�'/ q a C CONTRACTOR ADDRESS / �(/ ZV/L rH� 0, CITY/STATE/ZIP LICENSE 11 K-42 11CIC-36 OTHER NUMBER S7Vy_C EXPIRATION DATE WATER TABLE DEPTH: 15 y 1 g O ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT # O DS'DS'D LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION - REPAIR/ADDITION ❑ ENGINEER DESIGNED /ALTERNATIVE ❑ REPLACEMENT ❑ OUT -OF -SERVICE SEPTIC SYSTEM ❑ DESTRUCTION INSTALLATION WILL SERVE: ❑ RESIDENCE COMMERCIAL F1OTHER P!iAn O NUMBER OF LIVING UNITS: / NUMBER O BEDROOMS: e � NUMBER OF EMPLOYEES: - SEPTIC TANK TYPE/MFG �� H CrB� L CAPACITY ! POO gal # OF COMPARTMENTS OZ ❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS DISTANCE TO NEAREST: WELL .2040 ft FOUNDATION !O ft PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) J%I / LEACH LINES 11 LEACHING CHAMBERS Amount # OF LINES 3 / LENGTH OF LINES 57/ , ft Code INFO MBY, DISTANCE TO NEAREST WELL 2oc ft FOUNDATION V-02 ft PROPERTY LINE l0 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 ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL SEEPAGE PITS NUMBER 3 WIDTH ft 3 FOUNDATION ft PROPERTY LINE ft C 1. ft DEPTH os-, ft DISTANCE TO NEAREST WELL 12ag ft FOUNDATION 670 ft 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. MINIMUM 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 DEPARTMENT USE ONLY Application Accepted By � � G Date q113 42 / Area G Employee ID# I C1Z Final Inspection By �r,,,,' C(v (...-j4 �64^7_ Date SPECIAL PERMIT -Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS 1�evJ OOr )rtrc in y -)Of be In UsP. PE SC Received Check#/ Amount Permit/ Code INFO MBY, ash Remitted Date Invoice # Permit ID# Service Request # Lja)� asO 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18 I