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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT 1 SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 11UN-Rtr UNUAbLt rtKM1I DISTANCE TO NEAREST 6/4LL [UV J.7J-/DJ/ t•UK IN51'tGI1UN5 tAP'IKtS I T tAK t-K`UM UAIt 155UtL JOB ADDRESS ' G �- ` -� /� CITYIZIP J iL f I J CROSS STREET A' PN PSIZE / 1 OWNERNAME L:7 Cc F'zi ✓ ^ C: t"" �L.9 1 0-j \ 20c(-6,01-5076 OWNER ADDRESS _PHONE �/ 1 CITY/STATE/ZIP t1- �1 CONTRACTOR CONTRACTOR✓e-pT 5e rtj ce C, fZo/,-17 �ARC—EL --c PHONE Z 5 CONTRACTOR ADDRESS DEPTH ft CITYISTATE/ZIP 401 I40iV. GA956 C-42 . C-36 `Q �O SLICENSE OTHER NUMBER 10 7 7 WATER TABLE DEPTH: �/ IJ ft GEOGRAPHICAL INFORMATION: Coordinates X Y f F 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: RESIDENCE I COMMERCIAL�j I OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: - 7 NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPE/MFG liU�/V ❑ GREASE TRAP TYPEIMFG DISTANCE TO NEAREST: WELL ❑ LIFTSTATION SIZE TYPE OF PUMP CAPACITY CAPACITY ft FOUNDATION ❑ PKG TX PLANT gal # OF COMPARTMENTS gal # OF COMPARTMENTS ft PROPERTY LINE h ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) LEACH LINES LEACHING CHAMBERS # OF LINES _� LENGTH OF LINES S5 ft -1 DEPARTMENT USE ONLY J Application Accepted By Date 1t ' ! % Area 1 C Employee ID#bA Final Inspection By 1'f �:�1 G : 1 �� ✓te 7 Date .J SPECIAL PERMIT - Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil F`Character: '1;?c11COMMENTS p( , , I 4 + I I './ ,'t -;IC ,/ s, ";6j h'. ",/C-- k4er1 n v,7 y„ IT J Invoice # I Permit ION a2-01 4/'14/18 / / •• • - / /2Lj._575-2 q3 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 'T DISTANCE TO NEAREST WELL_, �O _ ft FOUNDATION 0-5- ft PROPERTYLINE It ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It ❑ MOUNDED WIDTH It LENGTH fl DEPTH ft DISTANCE TO NEAREST WELL fl FOUNDATION ft PROPERTY LINE ft ❑ SUMPS WIDTH It LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NE° -FST WELL ft FOUNDATION ft PROPERTY LINE ft �(I SEEPAGE PITS NUMBER i. WIDTH 3 ft 4 DEPTH 5- ft DISTANCE TO NEAREST WELL / SO ft FOUNDATION 15-(f> ft PROPERTY UNE. O r ft I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOApUIN COUNTY ORDINANCES, STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. MINIMUM 48 HOUR&RVANCE NOTME REQUIRED FOR INSPECTIONS - PLEASE CALL 953-7697 SIGNED TITLE Rill (� DATE Y--ZK `Z� -1 DEPARTMENT USE ONLY J Application Accepted By Date 1t ' ! % Area 1 C Employee ID#bA Final Inspection By 1'f �:�1 G : 1 �� ✓te 7 Date .J SPECIAL PERMIT - Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil F`Character: '1;?c11COMMENTS p( , , I 4 + I I './ ,'t -;IC ,/ s, ";6j h'. ",/C-- k4er1 n v,7 y„ IT J Invoice # I Permit ION a2-01 4/'14/18 / / •• • - / /2Lj._575-2 q3 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 'T