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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT F 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 I EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS / CITY/ZIP CROSS STREET U 1l �O Y / l LLJVJ ' APN �� PARCEL SIZE OWNER NAME� AIRCCA / NIIL/16j4& ,f Jy tl VI 1'Mq / PHONE `�I OWNER ADDRESS `-7V t l ��CZ(�(J�O�� dI/ /�CITY/STATE/ZIP W�I i `-eA CONTRACTOR t / l//J Vy,iA l4e(1 / PHONE CONTRACTOR ADDRESSTY/STATE/ZIP LICENSE D IC-42 [11;C-36 OTHER f7 (�►en�ra( NUMBER 0 —305EXPIRATION DATE WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION I ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: p J (� NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: i� �J SEPTIC TANK TYPE/MFG 1' -PL G�I`�ILf✓el-c CAPACITY I U00 gal #OF COMPARTMENTS C� ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS DISTANCE TO NEAREST: WELL It FOUNDATION It PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) LEACH LINES LEACHING CHAMBERS #OF LINES �- LENGTH OF LINES v ft DISTANCE TO NEAREST WELL ft FOUNDATION ft - PROPERTY LINE 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 I WIDTH / ? ft DEPTH I ft DISTANCE TO NEAREST- WELL &02 ft FOU DATION 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. HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL 209 953-769 7 SIGNED TITLE LM&jej DATE l LLQ -fit III v 117 N � U P DEPARTMENT USE, ONLY Application Accepted Date// Area Employee ID# 1�-- Final Inspection By Dat6D [ISPE AL PERMIT-Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS 2 U lli S C� ' " r 1 �k a 4s UdwiV'Iez <� L PE SC ReceivedChe Amount Date Permit/ Invoice# Permit ID# Code INFO B Remitted Service Request#' ZII - W1 13 20 Sko 091LOZ-- 2• �-01 (3x)- 6o� �� " " - 1 �x/ J ""/ ONSITE WASTEW TER RTM T SYST ERMIT 4/14/18