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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 W;1697 697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS CITYIZIP C 2 /y'f S7 � CROSS STREET �r�a'I� APN �J ^J�O^ PARCEL SIZE /. ` p OWNER NAME �l ll n e n PHONE �(; q�-/,//��✓ `�W E 3' 877 OWNER ADDRESS '.-J�,"v1-1"� CITY/STATE/ZIP / l�f/�^C CONTRACTOR f �' PHONE 6-�O� 3 -Tc1 f-� CONTRACTOR ADDRESS 1_I�1 •)�1 `1 T CITY/STATE/ZIP Q ` LICENSE ❑�C-42 ❑-_C_--1136 OTHER E NUMBERS 0--EXPIRATION DATE /.� WATER TABLE DEPTH: n7O V� jesS ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: L NEW INSTALLATIIOOA_ IK ` REPAIRIADDITION _ ENGINEER DESIGN D/AL RNATIVE REPLACEMENT '"�"•' /� OUT SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIALElOTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: -.7 NUMBER OF EMPLOYEES: SEPTICTANK TYPE/MFG CAPACITY F:3IvVy gal #OFCOMPARTMENTS_ ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS //tt DISTANCE To NEAREST: WELL 0 ft FOUNDATION._ ft PROPERTY LINE ./ ti/ ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) LL jF LEACH LINES G LEACHING CHAMBERS #OF LINES� �� LENGTH OF LINES "7d ft DISTANCE TO NEAREST WELL IS 6' ft FOUNDATION,_ft PROPERTY LINE -L11 1 ft ❑ FILTERBED 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 N^EAREST WELL ft FO NDATIIOI� ft PROPERTY LINE ft SUMPS WIDTH (�` ft LENGTH � I� It DEPTH ID ft DISTANCE TO NEAREST WELL ft FOUNDATION Q C l ft PROPERTY LINE 6 I ft ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft DISTANCE To NEAREST WELL 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. Mni&U�20UWADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-769 SIGNED ✓\ TITLE 0U"1(/m DATE ZO cotjjv 7y DEPARTMENT U SjE ONLY Application Accepte Date Area 5 % I Employee ID# Final Inspection B 11 Date ❑ SPECIAL PERMIT-Approved by Character of Soil to Depth of 3 Ft. Pit/Sump Soil Character: COMMENTS I/ S t hj -r/ /- o a I &0 Hca—&. PE SC Received C Amount Date Permit/ Invoice# Permit ID# Code INFO B ash Remitted erviceRe uest# 10 00 A 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18