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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HA2ELTON AVENUE -STOCKTON CA 95205 -(209) 468-3420 NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1/YEAR FROM DATE ISSUE[ JOB ADDRESS }y ✓l Irl ,_, CITYIZJP L ✓: 'v7 C ot DISTANCE TO NEAREST 7<-`��. Kms- 72-c e4 0( r1 Cf I � � J � � � CROSS STREET � Li WIDTH APN " -PARCELSIZE '^ ��/I / OWNER NAME / i I Ji4e S i-ClU c tO TIC _% / k PHONE OWNER ADDRESS ` S - 11 � V F� CITYISTATEJZIP 5) I/ t/7( F/J/.,n�y i� J `I %I' .%jam CONTRACTOR L1�! �Il `�U{v'J�/>^/�J`4 o /Ay" � � PHONE � 7 _ S V / �'�C7•%� CONTRACTOR�/A''DDRESS %qL �b •� CITY/STATE/7JPl ft'LI�f�'r✓1 ir ft FOUNDATION ft PROPERTY LINE ft LICENSE X42 C-36 OTHER NUMBER 4C r6 EXPIRATION DATE WIDTH r WATER TABLE DEPTH: Iia 1 J ft GEOGRAPHICAL INFORMATION: Coordinates X Y PERC TEST # I BUILDING PERMIT # LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION REPAIRIADmnoN ENGINEER DESIGNED /ALTERNATIVE REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: RESIDENCE COMMERCIAL OTHER NUMBER OF LIVING UNITS: I NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: LI/_J SEPTIC TANK TYPEIMFG LTIJ t11/1 CAPACITY gal #OFCOMPARTMENTS ❑ GREASE TRAP TYPF/MFG CAPACITY gal # OF COMPARTMENTS DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE It ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) I HEREBY CERTIFY THAT 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. x'021 i J DEPARTMENT /SE ONL(� Application Accepted By /--4��//�� Date C^ Area / Employee ID#_b_ Final Inspection By ' ► tyLC. S tw it wEilIt, OCLI� Date�2r�� 2--1 l SPECIAL PERMIT -Approved by Character of Soil to Depth of 3 Ft: PidSump, Soil Character: COMM `E �NTS Fr.Ti Git, s4lem Exi,: l/IG; linesmen, ,/n. T e/ C%G�t �n eaC�*,��n hhrS 0Gr GJ�s 1b F ,�Uf uie expa �,"On. PE SC Received Checkf# Amount Permitl Code INFO Alk, Remitted Pate I Service Re uest # Invoice # Permit ID# 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4114/18 LEACH LINES LEACHING CHAMBERS Ito,L.Es LENGTHOFLNES ' ft DISTANCE TO NEAREST / aC WELL / , ^ ft FOUNDATION ft PROPERTY LINE f;,a ft ❑ FILTER BED WIDTH ft 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 ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH R DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY ft SEEPAGE PITS NUMBER ( 1 WIDTH ft DEPTHC;Z) ft DISTANCE To LAMEST 7 WELL T_ ft FOUNDATION �� ft PROPERTY UNE ft I HEREBY CERTIFY THAT 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. x'021 i J DEPARTMENT /SE ONL(� Application Accepted By /--4��//�� Date C^ Area / Employee ID#_b_ Final Inspection By ' ► tyLC. S tw it wEilIt, OCLI� Date�2r�� 2--1 l SPECIAL PERMIT -Approved by Character of Soil to Depth of 3 Ft: PidSump, Soil Character: COMM `E �NTS Fr.Ti Git, s4lem Exi,: l/IG; linesmen, ,/n. T e/ C%G�t �n eaC�*,��n hhrS 0Gr GJ�s 1b F ,�Uf uie expa �,"On. PE SC Received Checkf# Amount Permitl Code INFO Alk, Remitted Pate I Service Re uest # Invoice # Permit ID# 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4114/18