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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 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS 1404k t-rA14M4-Y CITY/ZIP / CROSS STREET !/y"I',�Qj'Q/ /' r- APN OJ.�y w1 PARCEL SIZE OWNER NAME �1 ,7l b ?A �D U "�-� � �� PHONE OWNER ADDRESS OTHER CITY/STATE/ZIP NUMBER OF EMPLOYEES: ^]( SEPTIC TANK ' /�L J -)O C� / �^ CONTRACTOR '�"✓' ¢-J L PHONE • Z�I(�l [� f��/ CONTRACTOR ADDRESS J -/ ZlX J�7_ /""- CITY/STATE/ZIP ' LICENSE ❑111.-42 ❑_C36 OTHER NUMBER t'0 Sr EXPIRATION DATE SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND WATER TABLE DEPTH: 1V Vk-' It GEOGRAPHICAL INFORMATION: Coordinate X Y C PERC TEST # BUILDING PERMIT # AND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION _. ENGINEER DES-^MFD' WELL REPLACEMENT _ OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION _ INSTALLATION WILL SERVE: RESIDENCE E COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: UMBER OF BEDROOMS: 09— NUMBER OF EMPLOYEES: ^]( SEPTIC TANK TYPE/MFG v -'Y 3 ,,1 / V CAPACITY / �O gal # OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS DISTANCE TO NEAREST // DISTANCE To NEAREST: WELL C ft FOUNDATION O r ft PROPERTY LINE 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. MINIMUM HOUR ADVANCE N TICE REQUIRED FOR INSPECTJON4 - PLEASEL 2 953-7697 SIGNED - TITLE f i DATE Application Accepted Final Inspection By_ Character of Soil to C COMMENTS F !�ftetvr EIVE6 N 15 ?02, 4QUIN COP U E�Y Tm DEPARTMENT USE O LYI (_ �(% r Date l Area /�-lj / 6�( Employee ID# �,_G` i Date ❑ SPECIAL PERMIT -Approved by of 3 Pit/Sump Soil Character: 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4114/18 LEACH LINES LEACHING CHAMBERS # OF LINES ! LENGTH OF LINES / JJ 0.0 It DISTANCE To NEAREST WELL l �Q r ft FOUNDATION ft PROPERTY LINE �� r ft ❑ FILTER BED WIDTH ft LENGTH ft DEPTH it DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It ❑ MOUNDED WIDTH ft LENGTH ft DEPTH R DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It ❑ SUMPS WIDTH It LENGTH ft DEPTH It DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE It ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH It DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE It ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH It DISTANCE TO NEAREST WELL It 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. MINIMUM HOUR ADVANCE N TICE REQUIRED FOR INSPECTJON4 - PLEASEL 2 953-7697 SIGNED - TITLE f i DATE Application Accepted Final Inspection By_ Character of Soil to C COMMENTS F !�ftetvr EIVE6 N 15 ?02, 4QUIN COP U E�Y Tm DEPARTMENT USE O LYI (_ �(% r Date l Area /�-lj / 6�( Employee ID# �,_G` i Date ❑ SPECIAL PERMIT -Approved by of 3 Pit/Sump Soil Character: 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4114/18