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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 GALL ZU9 953-/69/ FOR INSPECTIONS 'I YEAR FROM DATjE ISSUE JOB ADDRESS _ 1 U J / Z_ "L; �/� h 2e . CITY/ZIP } OL 1tXPIRES 1 V {� r S � / rJ^ CROSS STREET �L I 1 APN C y f PARCEL SIZE - 4 61 OWNER NAME Z_,'��q �� /rte BUILDING PERMIT # PHONE OWNER ADDRESS ��% Z S �' 11� /�C /� ��9 ' CITY/STATE/ZIP ��V�1J�C I A 72 CONTRACTOR Y \/7'��5' 1 I� vP�//� J PHONE CONTRACTOR ADDRESS /U� �?�/"V, Z •� CITY/STATE/ZIP / °. Gi %� LICENSE ❑11C-42 ❑❑C-36 OTHER (( NUMBER?/ EXPIRATION EXPIRATION DATE Z - / 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. IYIIIVIIYI IYI -tug!7 /R ML.' VM/Y L 1Vw I 1%,L- RL IRC✓ r WUN I/Y rL I I /I IY - rLLMJL 14U.71 Val SIGNED i '� / TITLE /'_ is l/.�_ %(' � DATE S / �7 DEPARTMENT USE ONLY Application Accepte y y/�— �� Date S '�L� P Area < < Employee ID#�i� Final Inspection By Dates/ ' ❑ SPECIAL PERMIT -Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS l,a110115'V4ellvl' ,x_s -i>7 I✓i FS b�' �.� c>-'7 CID; PE Code SC INFO Received- B ash Amount RemittedService Date WATER TABLE DEPTH: / - C1 ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION ❑ REPAIR/ADDITION Ll ENGINEER DESIGNED /ALTERNATIVE ( REPLACEMENT C 11 I� t \ �� 11OUT-OF-SERVICE SEPTIC SYSTEM 10 DESTRUCTION t0; Yl INSTALLATION WILL SERVE: LTJ RESIDENCE El COMMERCIAL El OTHER NU MBERR OF LIVING UNITS: OF BEDROOMS: NUMBER OF EMPLOYEES: El SEPTIC TANK /NUMBER TYPE/MFG L G� �C �� f /� CAPACITY �/ l• �� J gal # OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS DISTANCE TO NEAREST: WELL1 ft FOUNDATION 1 ft PROPERTY LINE c ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) 2 •❑ LEACH LINES LEACHING CHAMBERS # OF LINES LENGTH OF LINES Y ft DISTANCE TO NEAREST WELL� ft FOUNDATION S ftPROPERTY 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 2 WIDTH / C ft DEPTH 2 j — ft DISTANCE TO NEAREST WELL Z -S" ft FOUNDrATION 7 - ft PROPERTY LINE a 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. IYIIIVIIYI IYI -tug!7 /R ML.' VM/Y L 1Vw I 1%,L- RL IRC✓ r WUN I/Y rL I I /I IY - rLLMJL 14U.71 Val SIGNED i '� / TITLE /'_ is l/.�_ %(' � DATE S / �7 DEPARTMENT USE ONLY Application Accepte y y/�— �� Date S '�L� P Area < < Employee ID#�i� Final Inspection By Dates/ ' ❑ SPECIAL PERMIT -Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS l,a110115'V4ellvl' ,x_s -i>7 I✓i FS b�' �.� c>-'7 CID; PE Code SC INFO Received- B ash Amount RemittedService Date Permit/ Request # Invoice # Permit ID# y i� pis 15-0 6,3 f30-0 kvq X114 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18 VA