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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 (ZU9) 9b3-7697 FOR INSPECTIONS LXPIRES 1 YEAR FROM DATE ISSUEI JOB ADDRESS 157 % (P(D AJ .. DEV Ie I ES /Z*t> CITY/ZIP L OD I CROSS STREET S,LG-r IN 1 Lp. APN �?"- Q PARCEL SIZE 3s:.I a A OWNER NAME -Jo' 054,VAJ XO �t-J PHONE (r4l) 233-730D OWNER ADDRESS SAV"c CITY/STATE/ZIP CONTRACTOR LIV t 0^-W- & 0C&JV1W-6#J*1F_J / j AL PHONE 3ib1-0319- CONTRACTOR ADDRESS "I 1 W • O Ay-- ST • CITY/STATE/ZIP L' CIV ( CA ':f Z 44 0 LICENSE C'.7C-42 i.7';. C-36 OTHER C k7c;'-NUMBER ?") EXPIRATION DATE d+ -30 -7-7— WATER ZZ WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y PERC TEST # I F BUILDING PERMIT # LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION _ REPAIR/ADDITION L ENGINEER DESIGNED/ALTERNATIVE DISTANCE To NEAREST WELL ._, REPLACEMENT _. OUT -OF -SERVICE SEPTIC SYSTEM I::I DESTRUCTION INSTALLATION WILL SERVE: L RESIDENCE LJ COMMERCIAL LI OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPE/MFG CAPACITY gal # OF COMPARTMENTS ❑ GREASETRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS DISTANCE TO NEAREST WELL DISTANCE TO NEAREST: WELL It FOUNDATION ft PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) ❑ LEACH LINES . LEACHING CHAMBERS # OF LINES LENGTH OF LINES ft Date Permit/ Invoice # Permit ID# Servic Re uest # DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE 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 ft FOUNDATION ft PROPERTY LINE ft ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION 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. MINIMUMMMMUMAJ HQUR ADVAKE NOTICE RE IRED FOR INSPECTIONS - PLEASE CALL (2 09) -7 7 SIGNED TITLE fA-VJ • k" &A • DATE S- 14 - 2- ) Final Inspection By L fr.li ASCO J94A4 1 & JQA4�j Character of Soil to Depth of 3 Ft: COMMENTS Date S Area L Employee ID# Date J IV j SPECIAL PERMIT - Approved by Pit/Sump Soil Character: YMF�T 9 2021 FS CO PE Code Sc INFO Received Check # Amount By Date Permit/ Invoice # Permit ID# Servic Re uest # rRemitted 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18