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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 (:ALLZUU19 Yb:/f-1051/ FOR INSPECTIONS LXPIRES I/YEAR FROM UATE ISSUE JOB ADDRESS /�C% / CITY/ZIP CROSS STREET / CQ / /l1 / APN 00 -7 Q -:- % c) LI / PARCEL SIZE t��c� OWNER NAME e- 0 y^ PHONE OWNER ADDRESS �Vo�/v CITY/STATE/ZIP A CGl WI.pU/ 9 s a al �b CONTRACTOR o n( / l �jv � Ile C �p PHONE 90 `/>- ��E�/ - S Q / % 0 CONTRACTOR ADDRESS / ��H ��" �' CITY/STATE/ZIP LICENSE II/If-42 11LIC-36 OTHER NUMBER 4T%� EXPIRATION DATE Cll3� a J WATER TABLE DEPTH: i 3o _ 130 ft GEOGRAPHICAL INFORMATION: Coordinates X V ❑ PERC TEST # BUILDING PERMIT # 20C-) t_' % q LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION J REPAIR/ADDITION !1 ENGINEER DESIGNED/ALTERNATIVE 1 REPLACEMENT I OUT -OF -SERVICE SEPTIC SYSTEM I ! DESTRUCTION INSTALLATION WILL SERVE: ' RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: 7 SEPTIC TANK TYPE/MFG 01?Cn0le- G CAPACITY / (:;bC�) gal # OF COMPARTMENTS lJ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS DISTANCE TO NEAREST DISTANCE TO NEAREST: WELL /00 ft FOUNDATION (/O / ft PROPERTY LINE �4%0 , ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) �j LEACH LINES ! I LEACHING CHAMBERS Invoice # Permit ID# # OF LINES LENGTH OF LINES SL,S , ft / \ DISTANCE TO NEAREST WELL f �ft _ /l FOUNDATION / O ! ft PROPERTY LINE 7 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 SEEPAGE PITS DISTANCE TO AR ST NUMBER WELL WIDTHZ ft FOUNDATION �/ ft ft PROPERTY LINE DEPTH �� l ft ft DISTANCE TO NEAREST WELL / SG ft //-- FOUNDATION (C�a ft PROPERTY LINE 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. Application Accepted By Final Inspection By Character of Soil to COMMENTS Gi�WI�� i��1c•�. SR DEPARTMENT U.SE ONLY Date d 1 Area Employee ID#_40A Date ❑ SPECIAL PERMIT -Approved by of 3 Ft: L ��/� Pit/Sump Soil Ch racter: �% y been Al ceme0 Co be, demo �/shri—i fArir-r RP - ,�n /� j17o1 y . SPio�lc. �PS�rut ��an pE'I avll I? I R n" PE Code SC INFO Received Check#/ Amount Date Permit/ BCash Remitted Service Request # Invoice # Permit ID# 9,911 H-7 ° 53 11-21 X00 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18