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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-KEFUNDABLE VERMII JOB ADDRESS CROSS STREET GALL (LU&) &0J -/6y/ FOR INSPECTIONS LXPIRES 9 YEAR FROM UATE ISSUEI CITY/ZIP APN 0073933- PARCEL SIZEqq OWNER NAME I/ I/) Al L? dr id ' PHONE OWNER ADDRESS �� . 9-7V CITY/STATE/ZIP •W fix^ �r I "'"►e 17 ld CONTRACTORV (��lC [ q ll eq �C` A / , PHONE �V C% - 3& , !20,217 - % CONTRACTOR ADDRESS 3 / (& XiLI'� 'o AI C.. �i ' J� CITY/STATE/ZIP s /\ C T Kcp/ ❑ LICENSE C-42 I][ IC -36 OTHER NUMBER "( 5-I'01SEXPIRATION DATE WATER TABLE DEPTH: l�e��/ -;30 ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # I BUILDING PERMIT # 3 10 D 1 LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION I I ENGINEER DESIGNED /ALTERNATIVE Permit ID# REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM I I DESTRUCTION INSTALLATION WILL SERVE:RESIDENCE ❑ COMMERCIAL C OTHER 13VI 0-0 NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: -]� NUMBER OF EMPLOYEES: �[ p)I SEPTIC TANK TYPE/MFG C L CAPACITY ld(Co ^� gal # OF COMPARTMENTS "` !❑� GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS DISTANCE TO NEAREST: WELL ! / OO "7 ft FOUNDATION ft PROPERTY LINE 50 ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) LEACH LINES I I LEACHING CHAMBERS # OF LINES( 3 I LENGTH OF LINES 575" ft DISTANCE TO NEAREST WELL (bt7 ft FOUNDATION ods 1 ft PROPERTY LINE �O ft ❑ FILTER BED 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 ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft SEEPAGE PITS NUMBER WIDTH Z /I 3 ft DEPTH -� / ft DISTANCE TO NEAREST WELL /SO 1 F ft FOUNDATION 6 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. DEPARTMENT USE ONLY Application Accepted By Date %C Area L1 "/ ,2 j Employee ID# Final Inspection By Date Lg (2I L -7 i ❑ SPECIAL PERMIT - Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS MOO S FIZ er i/ PE Code SC Receiv d INFO Check#/ Cash Amount Remitted Date Permit/ Invoice # Service Request # Permit ID# ud 1 117 - Z T 13VI 0-0 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18