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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 EXPI /RES 1 YEAR FROM DATE ISSUED JOB ADDRESS �� C, ' J CITY/ZIP LS ct1 an L� - 2531<> CROSS STREET C' ✓ '�� APN 0;3-70 (-- OR C1 PARCEL SIZE \%Z' OWNER NAME I �R l� 1 \ ' ' ` "�"�, _^ 1 S PHONE Z(' 1 OWNER ADDRESS _<>' VvL'-1 �CITY/STATE/ZIP CONTRACTOR (o w/r V�/ PHONE CONTRACTOR ADDRESS CITY/STATE/ZIP LICENSE 1111C-42 ❑OC -36 OTHER NUMBER EXPIRATION DATE i^ WATER TABLE DEPTH: ' �C7 ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT# O 5S LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION I I ENGINEER DESIGNED /ALTERNATIVE 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. DEPARTMENT USE ONLY Application Accepted By — Date I Area �i C Employee ID# /_ Final Inspection By �Date SPECIAL PERMIT -Approved by Character of Soil to Depth of 3 Ft:-PiNSump Soil Character: COMMENTS /fipr coin USCG!tr, 122019"(3- I lydor WiI1 I �rJY13 6Y,- PE am PE Code SEPTIC TANK TYPE/MFG Z1 L Permit/ Invoice # ervice Request # Permit ID# CAPACITY S gal # OF COMPARTMENTS ",>-- ❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS DISTANCE TO NEAREST: WELL J ft FOUNDATION 5 + ft PROPERTY LINE -2-9: ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) LEACH LINES LEACHING CHAMBERS # of LINES 2 LENGTH OF LINES / ft DISTANCE TO NEAREST WELL ft r FOUNDATION SV r ft PROPERTY LINE f 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 � I ft LENGTH dZ ft DEPTH �DISTANCE TO NEAREST WELL 3 c n ft FOUNDATION �� 4 ft PROPERTY LINE ft ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NE`Q BST WELL ft FOUNDATION ft PROPERTY LINE ft L3 SEEPAGE PITS NUMBER C/ WIDTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION -'F' ft PROPERTY LINE -Ir' 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. DEPARTMENT USE ONLY Application Accepted By — Date I Area �i C Employee ID# /_ Final Inspection By �Date SPECIAL PERMIT -Approved by Character of Soil to Depth of 3 Ft:-PiNSump Soil Character: COMMENTS /fipr coin USCG!tr, 122019"(3- I lydor WiI1 I �rJY13 6Y,- PE am PE Code SC Received (-'Check#> INFO B Amount Date Remitted Permit/ Invoice # ervice Request # Permit ID# �I� 1 0.7 S:?Li S.4. Z WO 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18 T Y d d m K,