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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEAT rH DEPARTMENT 1888 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 NON-REFUNDABLE PERMIT pCALL 209 933-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS J V/ I n I etz—1nµ1 11 C1TYIZIPy G t t)ri L :n CROSS STREET APN_ ''✓r O'1''✓ I G1 PARCEL SIZE F' OWNER NAMECrr CT��Vo(� L.L(, C r PHONE C OWNERADDRES�S /. 4�f 4.1='Y,SJ;'1 5E, _CITY/STATTJZIP �fl"I F'fl:11C 11(,J `jgjjj CONTRACTOR Y V/��L�ST Na. t Tr&hce 1)'1 G PHONE CONTRACTOR ADDRESS 33 r' 't„XW//��'� J 1 { Crry/STATE/ZIP-L-OJ , QA-�54"1O I LICENSE �1 C-42 I :C36{}.J OTHER A NUMBER G✓1_5-ExPIRATNTI DATE /.-JO2. " ' WATER TABLE DEPTH:&5S /••C't7 lO ft GEOGRAPHICAL INFORMAL ION: Coordinates X Y FERC TEST P BUILDING PERMIT'# LAND USE APPLICATION# TYPE OF WORK: NEW INSTALLATION V KEPAIR/ADDITIO I ENGINEER DESIGNED/ALTERNATIVE s K REPLACEMENT Irt/'Tk - OUT-OF-SERVICE SEPTIC SYSTEM / 1) ESTRUC71oN INSTALLATION WILL SERVE: RESIDENCE COMMERCIAL ❑ 0E X37 NUMBER OF LIVING UNITS: � NUMBER OF BEDROOMS: 4NUMBER OF EMPLOYEES: ,{y i0 SEPTIC TANK I YP=/MFG I lT 1 I t T A 1j(JV^ CAPACITY L(Jt),) (Jai 4 OF COMPARTMENTS_ ❑ GREASETRAP TYPJMFG CAPACITY gal #Or COMPARTMENT: DISTANCE TO NEAREST: WELL t!j'A f: FOUNDAHUN 1D{ it PROPERTY LINE `JT ft Cl LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) ❑ LEACH LINES LEACHING CHAMBERS #of LINES LENGTH OF LINES it l DISTANCE TO NEAREST WELL it FOUNDATION ft PRCPERTY LINE ft GI FILTER BED WIDTH U) it LENGTHZ-U ft DEPTH_ ft C^ DISTANCE TO NEAREST WELL N I A ft FOUNDATION _•'Y•' ft PROPERTY INE 5.3- f: 1 ❑ MOUNDED WIDTH ft LENGTH it DEPTH (I DISTANCE TO NEAREST WELLN FOUNDATION ft PROPERTY LINE It 13 SUMPS WIDTH fl LENGTH ft DEPIH it DISTANCE TO NFAREST WELL it FOJNDAT10N n FROPERTY UNE M ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft A DISTANCE To NEAREST WELL R FOUNDATION ft PRO-ERTY LINE ft ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft �C MFN DISTANCE TO NEAREST WEU. ft FOUNDATION ft PROPFPTYLIN= it F�Ll fw ..._....,._..._,_,.:_..._...._............... ._TAN .,..�_•..,..,-.1..1..-.1.....1.,.,--.,mo �.....�,._.m-NDATIO _ I HEREBY CERT FY THAT I HAVE PREPARFn THIS APPLICATION AND THE WORK WILL BE DONE IN ACCO NUANCE WITH SAN JOAQUIN COUNTY ORDINANCES, e L STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. '7{ 9 Ml IMU V N T/ ERE IR D N TON -PLEASE LL 2 -7 V J q 4 20? SIGNED nn-E t DATE 5 1 Z pgRT(:)uNrY �-- /V)- ca rc Ox W M -ja n41 cy=4 > � C0-- .L um MM �1 rn p / DEPARTMENT USE ONLY Application Accepted By �L L— Date ` Area 3 S1`x'k IDr� Fmployee ID# /Y{ Final Inspection ByDate Z.L. ems// /, SPECIAL PERMIT-Appruved by ro. Character of Sal to Depth of 3 Ft: PiHSurnp Sol Character: g ' COMMENTS SL/S+F1�! ri_I�y4 . EXI'.tlrti 11�lN IJ I'e{��rSIN a0Nrt1F'G�� 'L��F�t l� 'e r�1.31Lr1 bY tanrY IAC"� 3� Ubli W, 0 C.4 W2✓ A/n J ^ GTOC� )CV , 1.�.?I7t't_r ✓Pctl,;G��FyS v Whe,.1i f,t- ®: ytD-T 5(-giII-S fl 'TH 15 c•I J or,, PE SC Received Check#/ Amount Permltf Code INFOsh Remitted (r,Date S rviu a uest Invoice# Permit ID# 9310 .) - J �7 1 yj 42-01 4/14l18 �� i/�� CNSRE WASTEWATER TRTMNT SVR'EM PERMIT