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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-REFUNDABLE PERMIT -- CALL 209 953-7697 FOR INSPECTIONSG� EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS r7� Mei., ✓ 11-, LYS P_ CITY/ZIP )• 177A) 15 21 Z L pn{ ' //�� Q m CROSS STREET -A/1•? A LIL4 All / APN OF�j-1 � � � PARCEL SIZE e �7� O OWNER NAME fN be I, iA l l l/vY1 it/ C I P.0 e r PHONE y v OWNER ADDRESS// JCI V/' t ( CITY/STATE/ZIP c CONTRACTOR JG.t'-�Z PHONE 2- - 1 I 0 I 0 CONTRACTOR ADDRESS CITY/STATE/ZIP 7 LICENSE 11nC-42 ❑IIC--36+ OTHER / NUMBER �l IiI Z�� EXPIRATION DATE (P `/LI WATER TABLE DEPTH: VO ^�ry ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT# (9 I C 5-" LAND USE APPLICATION# TYPE OF WORK: �4 NEW INSTALLATION REPAIR/ADDITION I1 ENGINEER DESIGNED/ALTERNATIVE FI REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM Ll DESTRUCTION INSTALILATION WILL SERVE: RESIDENCE ❑ COMMERCIAL I ❑ OTHER NUMBER OF LIVING UNITS: /i c- N_UM�BER OF BEDROOMS: `I NUMBER OF EMPLOYEES: SEPTIC TANK TYPE/MFG ?4L L-coYez, . CAPACITY ZOCJG gal #OF COMPARTMENTS 2— Ll ❑ GREASE TRAP TYPE/MFG '�` CAPACITY 1 gal #OF COMPARTMENTS DISTANCE TO NEAREST: WELL Ak ft FOUNDATION 1 ft PROPERTY LINE VO I01 ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) LEACH LINES IK LEACHING CHAMBERS I✓Q b(.'> #OF LINES Z LENGTH OF LINES CoF ft DISTANCE TO NEAREST WELL 104", ft FOUNDATION /C ft PROPERTY LINE /C 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 L�I WIDTH �{4 1) ft DEPTH 25 J ft DISTANCE TO NEAREST WELL /DO ft FOUNDATION 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. MINIMU 8 HOUR ADVAMCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 SIGNED Lam- TITLE C)lc> C41' DATE 02* r: / N DEPARTMENT USE ONLY Application Accepted Date 3//S41 Area Employee ID#1 Final Inspection By Date ?� C SPECIAL PERMIT-Approved by Character of Soil to Depth of 3 Fit Pit/Sump Soil Character: COMMENTS IR 10049 7 >GI , to I�o� o% I .,raj oi0 SAIn04 C/S 'r1214f�^W' FIs or, ' v c F p, . eT c S -Wir4l SGn K ao2( PE SC Received Check#/ Amount Date Permit/ Invoice# Permit ID# Code INFO B s Remitted Service Re uest# 93134 j?L 3 X5.2 VV U 42-01 j� ,M I (q Cod (-d 1220INSSII�WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18 U✓l ` Y