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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 PERMIT (;ALL IZU9) yb3-[0Y1 FOR INSPECTIONS LXPIRES "I YEAR FROM DATE ISSUEI JOB ADDRESS •,. LF S o� 'far ecS46 2-60 ,/{— C e`eeK- LMi f CITY/ZIP CROSS STREET %�t�/'pw �, L (�-pGi'G� APN �Q S / �' PARCEL SIZE OWNER NAME ?10 bel- pQG</f�^7(/7 PHONE OWNER ADDRESS P" L� / .St'1 CITY/STATE/ZIP 6jjl-t CONTRACTOR Cie Ar6rl 1 /l�"� / -Cyll/L"/�.5��IL ,�/� /� PHONE CONTRACTOR ADDRESS 3 / ��y ✓ TT/(4/// CITY/STATE/ZIP T SQDys-- �%3 a LICENSE �_� I1. -42 � C-36 OTHER NUMBER EXPIRATION DATE WATER TABLE DEPTH: XV ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT # ,Y y LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED /ALTERNATIVE REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTHER Invoice # NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: ? NUMBER OF EMPLOYEES: SEPTIC TANK TYPE/MFG 3 CAPACITY I�o� gal # OF COMPARTMENTS 2 ❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS y 60 f DISTANCE TO NEAREST: WELL /IrOQ ft FOUNDATION e00 ft PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANTEll SAND OIL SEPARATOR (ENCLOSED SYSTEM) L" J, ')y —2 LEACH LINES ❑ FILTER BED ❑ MOUNDED ❑ SUMPS LEACHING CHAMBERS ' ` rz # OF LINES DISTANCE TO NEAREST WELL /OQ 'P ft FOUNDATION_ WIDTH ft LENGTH DISTANCE TO NEAREST WELL ft FOUNDATION WIDTH ft LENGTH DISTANCE TO NEAREST WELL WIDTH ft LENGTH DISTANCE TO NEAREST WELL LENGTH OF LINES ft PROPERTY LINE ft ft DEPTH ft PROPERTY LINE ft DEPTH ft FOUNDATION ft PROPERTY LINE ft DEPTH ft FOUNDATION ft PROPERTY LINE ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft �^ DISTANCE TO NEA ST WELL ft FOUNDATION ft PROPERTY LINE ft Jill SEEPAGE PITS NUMBER WIDTH �,Q ft DEPTH (( �� DISTANCE TO EAREST WELL O ft FOUNDATION 001, ft PROPERTY LINE CPU 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. MINIMUM 48 HOUR ADVANCES NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 SIGNED TITLE G.«e.-44— DATE 6 — 199 -e2 I /J/ ,% DEPARQrMENT USE ONLY �J Application Accepted G{�2— Date d� �;7) Area �1 Employee ID# r " Final Inspection By Date 19 /Zap '2 ❑ SPECIAL PERMIT -Approved by Character of Soil to De of 3 Ft: Pit/Sump Soil Character: COMMENTS tJevj SFR. Per SS/'J LS �'epH2 Sysfeiy, 4-ob,(-, o'VR s) -zed. 'I/ayLdWO 99-227F9Qi5 PE Code SC Received INFO B hec h Amount Date . Permit/ Remitted I Service Re uest # Invoice # Permit ID# 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18