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JOB ADDRESS CROSS STREET OWNER NAME icaS /v• wHITE e- 62V 141 o ozerl-e-S- PARCEL SIZE c', *910 AC • PHONE 6,4 0 CS-44 L9 CITY/STATE/ZIP ciTyizip s----r-D is./ ra 5- OWNER ADDRESS S WVI APN lot-D -10-30 CONTRACTOR (—I Vt QA14 6-eto e Ili 2 0--"Jell k ,N) T -A I- PHONE 3 Le 031 CONTRACTOR ADDRESS 4 01 LO oAie- ST. cirdsTATEIzip L-obl, c—A 140 LICENSE • C-42 UL IC-36 OTHER Ce.." NUMBER 2 1 SH EXPIRATION DATE -f 3 0 - Wi 1 1 1 1 1 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. MINIMUM OUR 7NCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209)953-7697 SIGNED TITLE /9 /2 0-1. vri DATE 3-2 r 2 I I I1 1 1 I. 1 1 1 1 1 I I 1 1 1 1 1 I I I PAYMENT ECEIVED MAR 2 9 2021 SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1 I I 1 El —1 ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209)468-3420 NON-REFUNDABLE PERMIT CALL (209) 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION REPLACEMENT REPAIR/ADDITION OUT-OF-SERVICE SEPTIC SYSTEM H ENGINEER DESIGNED /ALTERNATIVE . DESTRUCTION INSTALLATION WILL SERVE: LI RESIDENCE NUMBER OF LIVING UNITS: 0 COMMERCIAL NUMBER OF BEDROOMS: U OTHER NUMBER OF EMPLOYEES: 0 0 0 SEPTIC TANK TYPE/MFG 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 13 PKG TX PLANT U SAND OIL SEPARATOR (ENCLOSED SYSTEM) 0 LEACH LINES LEACHING CHAMBERS # OF LINES LENGTH OF LINES DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft 0 FILTER BED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft CI MOUNDED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft 0 SUMPS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft 0 DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft 0 SEEPAGE PITS NUMBER WIDTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft DEPARTMENT U,E ONLY Date .74:, .17 Area Ll/qt) Date r31/162-1 7 SPECIAL PERMIT - Approved by Pit/Sump-SetSharacter: 11-46 jerl; )7A—A, II • 0157.1-) PE Code SC INFO Received , Check#/ Amount Remitted Date . Permit/ Service Request # Invoice # Permit ID# Lla d S-.7 3 1 142-J SPX g,4r-ii 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT PERC TEST # BUILDING PERMIT # Application Accepted Final Inspection By : I Character of Soil Depth of 3 Ft: ?y COMMENTS tet- • y Employee ID# 4/14/18