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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 IYUN-MtFUNUAtiLt YtKMI I GALL (ZU8)80J-168/1��FO/R INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUI JOB ADDRESS R `'�9,�t (� A " &I't ^CITY//ZIP C CROSS STREET 4]YYL'r�� R APN_OD70030 PARCELSIZE • - P OWNER OWNER ADDRESS Sc m ey CITY/STATE/ZIP /[ / /; CONTRACTOR /V/� (y�� //'' PHONE `�� yjS/ ��j�5b; CONTRACTOR ADDRESS 4 (L tr-s✓ )�'►� k1 DI. CICITY/STATE/ZIP �7V cy/�+�I . 6_147: LICENSE ❑-42 ❑C-36 OTHER NUMBER .( EXPIRATION DATE WATER TABLE DEPTH: 1 Id — l a b ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # I BUILDING PERMIT# LAND USE APPLICATION # TYPE OF WORK: L: NEW INSTALLATION REPAIR/ADDITION = ENGINEER DESIGNED /ALTERNATIVE L REPLACEMENT = OUT -OF -SERVICE SEPTIC SYSTEM L DESTRUCTION INSTALLATION WILL SERVE: Yr IRESIDENCE E]COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: ROOMS: NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPE/MFG `c404 h,4?1 CAPACITY gal # OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) L� LEACH LINES C LEACHING CHAMBERS # OF LINESL LENGTH OF LINES ft �1 Amount ate DISTANCE TO NEAREST n WELL IOo ft FOUNDATION f� S' C ft PROPERTY LINE �% o ft ❑ FILTERBED 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 It DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH It SEEPAGE PITS DISTANCE TO NEAREST NUMBER WELL ft FOUNDATION WIDTH 3 ft ft PROPERTY LINE ft DEPTH d7 l ft ((( DISTANCE TO NEAREST WELL /s'a ft FOUNDATION S ft PROPERTY LINE ®D r 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. �J DEPARTMEN U E ONLY p Application Accepted By L Date t Area / G Employee ID# FR Final Inspection By Date Y ( ❑ SPECIAL PERMIT -Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS Fe.j i1(l rl f azole TI Pt o :-J y,LIN ' SP f'6X'i(. S rJ6 k L ll pec. -fps Ci+S� S�51tM' 4-* eemm 4 i - 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4114/18 PE Sc Received / Amount ate Permit/ Invoice# Permit ID# Code INFO Cash Remitted Service Re uest# 4,210 i s U �a� 3 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4114/18