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z H Zr Uj 4r W O u% Q J °� z N UJ uj CrCn z W ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOC KTON CA 95205 -(209)468-3420 JOB ADDRESS CROSS STREET 953-7697 FOR INSPECTIONS t:XPIRES 3 YEAR FROM DATE Ilr n] i7lP A-e-,6m"Ic_ 1 APN C) D'� / J 1 `� PARCEL SIZE OwHER NAME / V,"t:- f f V 5 �f 11 "Cly NONE a C OWNER ADDRESS J C M l LLQ f�� V / CITYISTATE/LP (/AJC'(! CONTRACTOR PHONE L CONTRACTOR ADDRESS --/ '7L' 1I ^ CITYISTATEIZIP LICENSE 42 C36 OTHER NUMBER S �!`' , EXPIRATION DATE WATER TABLE DEPTH: J ft GEOGRAPHICAL INFORMATION: Coordinates X Y PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED /ALTERNATIVE REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: ARESIDENCE COMMERCIAL OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: a NUMBER OF EMPLOYEES: SEPTIC TANK TYPE/MFG 6,-,C wk &J L U GREASE TRAP TYPE/MFG DISTANCE TO NEAREST: WELL /no ❑ LIFT STATION SIZE TYPE OF PUMP CAPACITY /goo gal # OF COMPARTMENTS CAPACITY gal #OF COMPARTMENTS ' ft FOUNDATION ft PROPERTY LINE ft - ❑ 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. DEPARTMEN US ONLY Application Accepted By �' ��- <<" Date ^ ' Area C1/ e"M Employee ID#_F Final Inspection By Date S/f//i t, / � SPECIAL PERMIT -Approved by q Character of Soil to Depth of 3 Ft: Pit/Sump Soil Charac r: COMMENTS ReC�7/LrMPY11 -SFV pp(0''JA' by G%i'J:9�'- //^}t,a f{- /1t' h. PE SC Received Che Amount Dabs Permltl Invoice # Permit ID# Code INFO Remitted _S i e Re # I zZ sC 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18 M z Cn MZ i!1 1 „ Ic A Q mC: 49 z LEACH LINES LEACHING CHAMBERS # OF LINES LENGTH OF LINES -� ft DISTANCE TO NEAREST WELL 'M _ I `q R FOUNDATION / � ft PROPERTY LINE ft ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE ft ❑ MOUNDED WIDTH It LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE ft ❑ SUMPS WIDTH ft LENGTH ft DEPTH A DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ DISPOSAL PONDS WIDTH It LENGTH ft DEPTH At H �/RI �J DISTANCE TO NEAREST �� WELL ft FOUNDATION ft PROPERTY LINE 1G SEEPAGE PITS NUMBER WIDTH DEPTH DISTANCE TO NEAREST WELL �^�2_ft / :s'CJ R FOUNDATION S r It PROPERTY LINE (E 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. DEPARTMEN US ONLY Application Accepted By �' ��- <<" Date ^ ' Area C1/ e"M Employee ID#_F Final Inspection By Date S/f//i t, / � SPECIAL PERMIT -Approved by q Character of Soil to Depth of 3 Ft: Pit/Sump Soil Charac r: COMMENTS ReC�7/LrMPY11 -SFV pp(0''JA' by G%i'J:9�'- //^}t,a f{- /1t' h. PE SC Received Che Amount Dabs Permltl Invoice # Permit ID# Code INFO Remitted _S i e Re # I zZ sC 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18 M z Cn MZ i!1 1 „ Ic A Q mC: 49 z