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_ s r 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 JOB ADDRESS Z r CITY/ZIP d" CROSS STREET APN oC I 0=I Oa ti PARCEL SIZE 0 0 OWNER NAME CG ✓ 1-?4" PHONE OWNERADDRESS PU -x — CITY/STATE/ZIP / jC1WM� �'7 CONTRACTOR k e ,/, PHONE 264—:501:;t7 CONTRACTOR ADDRESS S Z! &In m ,/J� CITY/STATE/ZIP LICENSE ❑ C 7 -42 ❑_C-36 OTHER NUMBER 54Io 415 EXPIRATION DATE WATER TABLE DEPTH: q V �y ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: NEW INSTALLATION _ REPAWADDITION ENGINEER DESI NED/ LTERNATIVE G REPLACEMENT >< -IQ _ OUT-OF-SERVICE SEPTIC SYSTEM X DESTRUCTON 10911 INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: 3 NUMBER OF EMPLOYEES: SEPTIC TANK TYPE/MFG Q CAPACITY /wO Jai #OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS DISTANCE TO NEAREST: WELL� ft FOUNDATION ft PROPERTY LINE CAF It ❑ LIFTSTATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) LEACH LINES F LEACHING CHAMBERS /, #OF LINES � LENGTH OF LINES S ft DISTANCE TO NEAREST WELL 4L O ft FOUNDATION /10 / ft PROPERTY LINE O / ft ❑ FILTER BED WIDTH ft LENGTH ft DEPTH It DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft ❑ MOUNDED WIDTH It LENGTH It DEPTH ft \ DISTANCE TO NEAR�ST WELL ft FOUNDATION ft PROPERTY LINE ft SUMPS C� 1 WIDTH ft LENGTH �IK ft DEPTH t9' It DISTANCE TO NEAREST WELL � ft FOUNDATION ft PROPERTY LINE ❑ DISPOSAL PONDS WIDTH ft LENGTH It DEPTH It DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ SEEPAGE PITS NUMBER WIDTH It DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It 1 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 INSPECTION PLEASECALL(209)953-7697 n SIGNED TITLE / DATE Z '-cP8 l7CI ENT VED 2020 COUNTY ENTAL ARTMENT DEPARTMENT US6 ONLY Application Accepted r —�—�� Date /.7 d .20;D Area q Employee ID# r,)A Final Inspection By Date ❑ SPECIAL PERMIT-Approved by Character of Soil to Depth of 3 Ft: Pit/ ump Soil Character: COMMENTS Fodure c( Sysi'am, EXIsE,vlt -sy5lewl „, e-ti ln,( lot Wells to `,4' Sn fief PM10 scDh4 Lwiy1/<. IF ;<h lines oln,'/ 15u%on S_ PE SC Receive Check#/ Amount Date Permit/ Invoice# Permit ID# Code INFO ash Remitted Service Re uest# 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18