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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 FERMIT CALL LUy y5:f-1b,9/ FOR INSPECTIONS LXPIRES 1�gYEAR FROM DATE ISSUE[ JOB ADDRESS 17 YOO E d �f en be- rf. AA ` �7 rlj! CITY/ZIP & Gt l 0/1 , C PT -9 S 3,z c �] CROSS STREET 55) (�CG�c APN [i ` ` - - PARCEL SIZE o OWNER NAME Lon ffu�-] �V oLI �L� PHONE 1 �) ` 0?-- 757( 7 OWNER ADDRESS ` / 7 En C� PJ��SIe (^U4 CITY/STATE/ZIP i S C l V( 04 !S3ZLI CONTRACTOR e PHONE CONTRACTOR ADDRESS ^ CITY/STATE/ZIP LICENSE ❑FIC -42 01 -IC -36 OTHER NUMBER EXPIRATION DA WATER TABLE DEPTH: go - I �� ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT # E P d A> LAND USE APPLICATION # TYPE OF WORK: W NEW INSTALLATION REPAIR/ADDITION ❑ ENGINEER DESIGNED /ALTERNATIVE i. REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM LI DESTRUCTION INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL C OTHER NUMBER OF LIVING UNITS: 1 NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: SEPTIC TANK TYPE/MFG D J ' "�� i1� CAPACITY gal # OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS t DISTANCE TO NEAREST: WELL )(� T ft FOUNDATION S ft PROPERTY LINE )J+ ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) 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. ft ft ft ft ft ft ft ft ft ft ft ft DEPARTMENT USE ONLY Application Accept;epth �— v Date f �v U Area �� Employee ID#_ 6- Final Inspection By Date 11 SPECIAL PERMIT - Approved by Character of Soil to of 3 Ft: 1 Pit/Sump Soil Character: COMMENTS /JeVJ :FK S7r rj0e,.-7 ger .T� /�Jo vJells ! �I,,Y! rrf <c�5 of-� ��-lD r�ec�l�S PE Code Sc INFO Received B heck ash Amount Remitted Date Permit/ Service Request # Invoice # Permit ID# �-la I I ST a LEACH LINES LEACHING CHAMBERS '� OO�I � # OF LINES LENGTH OF LINES DISTANCE TO NEAREST WELL 270 ft FOUNDATION 10t ft PROPERTY LINE y ❑ FILTER BED WIDTH ft LENGTH ft DEPTH DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ❑ MOUNDED WIDTH ft LENGTH ft DEPTH DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ❑ SUMPS WIDTH ft LENGTH ft DEPTH DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE Id SEEPAGE PITS NUMBER 3 WIDTH 61 Z ir,ct,eS ft DEPTH 7-5- SDISTANCE DISTANCETO NEAREST WELL Z'i�% ft FOUNDATION )0T ft PROPERTY LINE `40 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. ft ft ft ft ft ft ft ft ft ft ft ft DEPARTMENT USE ONLY Application Accept;epth �— v Date f �v U Area �� Employee ID#_ 6- Final Inspection By Date 11 SPECIAL PERMIT - Approved by Character of Soil to of 3 Ft: 1 Pit/Sump Soil Character: COMMENTS /JeVJ :FK S7r rj0e,.-7 ger .T� /�Jo vJells ! �I,,Y! rrf <c�5 of-� ��-lD r�ec�l�S PE Code Sc INFO Received B heck ash Amount Remitted Date Permit/ Service Request # Invoice # Permit ID# �-la I I I I 1 2.. fs 12•�I.2p '� OO�I � 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18