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JOB ADDRESS Ocik 1.,4" ooa. 12/40 CROSS STREET 5 Li _761, +.1 OWNER NAME OWNER ADDRESS ) ty HOOG/ 19-e, 11/2 i; phy F &m (L LL ( ciTymp st ocK-itv. e PARCEL SIZE PHONE CITY/STATE/ZIP E:.5( (IL (7c3;2DtAi APN gs-oK061 CONTRACTOR vitt,:Ls A .R-e-g.t. PHONE 1-4 cC.• CONTRACTOR ADDRESS P-r) go )( E CITY/STATE/ZIP 1410/1 ri•-•-.C, ' ie- 6 LICENSE r C-42 CI C-36 OTHER A- NUMBER CeO EXPIRATION DATE - E PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # NEW INSTALLATION REPLACEMENT ett c4 C RESIDENCE Li COMMERCIAL , ENGINEER DESIGNED /ALTERNATIVE DESTRUCTION e , el E OTHER NUMBER OF EMPLOYEES: TYPE OF WORK: REPAIR/ADDITION OUT-OF-SERVICE SEPTIC SYSTEM INSTALLATION WILSERVE: NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: LENGTH OF LINES ft PROPERTY LINE ft FOUNDATION # OF LINES ft PROPERTY LINE ft LI DISPOSAL PONDS WIDTH ft LENGTH DISTANCE TO NEAREST WELL ft FOUNDATION SEEPAGE PITS NUMBER WIDTH DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft DEPTH ft PROPERTY LINE ft DEPTH ft ft ft ft ft ft ft ft ft ft LEACH LINES FILTER BED MOUNDED CI SUMPS DISTANCE TO NEAREST WIDTH DISTANCE TO NEAREST WIDTH DISTANCE TO NEAREST WIDTH DISTANCE TO NEAREST WELL ft LENGTH WELL ft LENGTH WELL ft LENGTH WELL LEACHING CHAMBERS ft FOUNDATION ft FOUNDATION ft FOUNDATION ft DEPTH ft PROPERTY LINE ft DEPTH ft PROPERTY LINE ft DEPTH 43/44, kiC1 " A 4.4YWCol A,, /El 2? 2021 , 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 WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Li/ SEPTIC TANK TYPE/MFG ,d- 1- CAPACITY -144G5t) /600gal # OF COMPARTMENTS GREASE TRAP TYPE/1\4FG CAPACITY gal # OF COMPARTMENTS DISTANCE TO NEAREST: WELL ( ft FOUNDATION ft PROPERTY LINE 1-01 ft LIFT STATION SIZE TYPE OF PUMP PKG TX PLANT 0 SAND OIL SEPARATOR (ENCLOSED SYSTEM) 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 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 SIGNED TITLE C-0(N.).4--c-e—i-o C DATE C Application Accepted By LL Final Inspection By'aZiOlf5V\ 9131342 Character of Soil to Depth of 3 Ft: COMMENTS DEPARTMENT UST ONLY Date ,j)-7/..4' / Area Employee ID# A 6 Date (/) ) %) "Z...Z>2A C SPECIAL PERMIT - Approved by Pit/Sump Soil Character: fre re,icten6e bielot f re1oe4,4 teal k PE Code SC INFO Received By heck#t ----GerSti Amount Remitted Date Permit/ Service Request # Invoice # Permit ID# LiaDel lic di6 1 sig2.--- .43o 5/2-7/2" 5R-00S37 SO ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 42-01 4/14/18