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ft GEOGRAPHICAL INFORMATION: Coordinates X BUILDING PERMIT # LAND USE APPLICATION # 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 vo them L cirdzi, od, CROSS STREET L-1 ei? 5 .3_,.12Cc €211., 4 APN - 4.4)/ 7 PARCEL SIZE OWNER NAME d /g 6 H- e-‘c PHONE1 , —Z 5-1 I OWNER ADDRESS 5-1/(6))11 CITY/STATE/Zip - 4 ee 11 CONTRACTOR 5 ato-fri Seri) izotce CONTRACTOR ADDRESS PO x JOB ADDRESS PHONE 916 — 366 - 1 11 CITY/STATE/ZIP k.)/ 14-0/1/ CA 95693 LICENSE C-42 : C-36 OTHER NUMBER I Oh KO !EXPIRATION DATE g1 --- E PERC TEST # I WATER TABLE DEPTH, 1::"6 TYPE OF WORK: NEW INSTALLATION REPLACEMENT l e_AIR/ADDITION--) UT-OF-SERVICE SEPTIC SYSTEM ENGINEER DESIGNED /ALTERNATIVE DESTRUCTION INSTALLATION WILL SERVE: 7.- RESIDENCE COMMERCIAL I OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: lits SEPTIC TANK 0 GREASE TRAP LIFT STATION SIZE TYPE OF PUMP 0 PKG TX PLANT U SAND OIL SEPARATOR (ENCLOSED SYSTEM) LEACH LINES LEACHING CHAMBERS # OF LINES LENGTH OF LINES 577 ft ft FOUNDATION / 0 ft PROPERTY LINE I ft ft LENGTH ft DEPTH ft ft PROPERTY UNE ft ft DEPTH ft ft PROPERTY UNE ft ft LENGTH SEEPAGE PITS NUMBER WIDTH ft DEPTH c". 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. TYPE/MFG 414/3 CAPACITY I oc) gal # OF COMPARTMENTS TYPE/MFG CAPACITY gal # OF COMPARTMENTS DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft DISTANCE TO NEAREST WELL I 0c7 FILTER BED WIDTH DISTANCE TO NEAREST MOUNDED WIDTH DISTANCE TO NEAREST SUMPS WIDTH DISTANCE TO NEAREST DISPOSAL PONDS WIDTH DISTANCE TO NEAREST WELL ft FOUNDATION ft LENGTH WELL ft FOUNDATION ft LENGTH WELL ft FOUNDATION ft PROPERTY LINE ft ft DEPTH ft WELL ft FOUNDATION ft PROPERTY LINE ft ft DEPTH ft PAYMENT RECEIVED APR 0 1 2021 JO IA COUNTY ONMENTAL firEPITH DEPARTMENT ENNA Application Accepted Final Inspection By Character of Soil to Depth of 3 Ft: COMMENTS 1.D CAST - Vi#V- /•-• F PARTMEN S ONL Area Employee ID#AtitiV) 1-02-1 SPECIAL PERMIT - Approved by Pit/Sump Soil Character: ni -S I've 117CW- PE Code SC INFO Receive f ti Checidt/ , Cash I/ 11.7'—‘• .' Amount I Date Permit/ Service Request # Invoice # Permit ID# VI 0 (CS , ; 4'6 ( '.5 Et i I Ill S POOP VCI 1 , 42-01 4/14/18 64.41 /23o ONSITE WASTEWATER TRTMNT SYSTEM PERMIT