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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-MEFUNDABLE PERMIT GALL (ZUY) 9b3-76Vf FOR INSPECTIONS LXPIRES 1 YEAR FROM DATE ISSUEQ JOB ADDRESS �j -1 O CrO P'.. 311f- l i -T I—PCNy LA) • CITY/ZIP AC. A-YA . P 0 1 CROSS STREET 1�LK APN 00-1-0-10-311 e PA1RC.EEL SIZE 4 ' f -K At OWNER NAME 5 PK � S L•6y T PHONE—(941 1 - -1 cl (a 5 OWNER ADDRESS z -o xook3 • mAQA,Jj Liv. STE • f CITY/STATE/ZIP L-bD ( CA z� Z CONTRACTOR LAV r- Oy \!w- /KE:T-r:-E PHONE 3 b 9 - o'31 S' CONTRACTOR ADDRESS 40 -1 w • 0 a)L S 1 CITY/STATE/ZIP L -0-1>t C*p ` C?S 1 L./<D LICENSE C-42 __. C-3^66 JOTHER C' ECS NUMBER Z i S- I EXPIRATION DATE 4- _ 3 - t Z W.—T....nco l 6 11 v v ❑ LEACH LINES LEACHING CHAMBERS PERC TEST # BUILDING PERMIT # ❑ FILTER BED LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE ❑ MOUNDED WIDTH REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: RESIDENCE 0 COMMERCIAL F OTHER WIDTH NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPE/MFG CAPACITY 981 # OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY 981 # OF COMPARTMENTS DISTANCE TO DISTANCE TO NEAREST: WELL ft 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 WELL DISTANCE TO NEAREST ❑ FILTER BED WIDTH It FOUNDATION ft LENGTH DISTANCE TO NEAREST ❑ MOUNDED WIDTH WELL DISTANCE TO NEAREST ❑ SUMPS WIDTH ft FOUNDATION DISTANCE TO NEAREST ❑ DISPOSAL PONDS WIDTH DISTANCE TO NEAREST ❑ SEEPAGE PITS NUMBER DISTANCE TO NEAREST # OF LINES WELL ft FOUNDATION ft LENGTH WELL It FOUNDATION ft LENGTH WELL ft FOUNDATION ft LENGTH WELL IS FOUNDATION ft LENGTH WELL ft FOUNDATION WELL ft FOUNDATION LENGTH OF LINES ft ft PROPERTY LINE ft ft DEPTH ft ft PROPERTY LINE ft ft DEPTH ft ft PROPERTY LINE ft ft DEPTH ft ft PROPERTY LINE ft ft DEPTH It ft PROPERTY LINE ft II DEPTH ft 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. M NHOUR ADVANCEN I E REQUIRED FOR INSPECTIONS - PLEASE CALL 209) 953-7697 SIGNED TITLE �D•� ' (s DATE 2- ENT cHu� ui u r.. riwuuiP oun COMMENTS'Pepea-er'L-. /' �¢ /O•�7+�•' ..�4RECEIVED Y 21 2021 42-01 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18 N COUNTY MENTAL :)ARTMENT