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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1668 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468.3420 NON-REFUNDABLE PERMIT CALL 209 953-7697FOR INSPECTIONS XPIRES 1 YEAR FROM DATE ISSUE[ JOB ADDRESS -La332 CITY2IP O CROSS STREET (WV 6✓i ke- Rd. E /^• �t� �AP,N L.0 3 d3 -o3 PARCEL SIZE h , OWNER NAME \ 0014 by C068Cwmiini W Vr�y YCi1 1 PHONE 1 7 OWNER ADDRESS V ` L `� CITY/STATE/ZIP /^�L.-'�vi T` ✓ I •.�/r��.�Ci� J J� �i CONTRACTOR West Coast &Ckhoe, Inc. PHONE•� �/�� •/`•y✓ �95,2-4c) � U f� CONTRACTOR ADDRESS 33 Max we 11 S�- • S CITYISTATE/ZIP LD D( 'I l.." -1 5,� 1 c+ LICENSE L1, -C-42 C-36 OTHER A NUMBER l! I' 5-7 EXPIRATION DATE D 2-3 WATER TABLE DEPTH: i� �`--� ft GEOGRAPHICAL INFORMATION: Coordinates X Y PERC TEST # BUILDING PERMIT# .A LAND USE APPLICATION # TYPE OF WORK: w NEW INSTALLATION REPAIR/ADornON ENGINEER DESIGNED /ALTERNATIVE REPLACEMENT OUT -0F -SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: RESIDENCE -.. COMMERCIAL 3 OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: NJ SEPTIC TANK TYPE/MFG CAPACITY 1 j. VLJ gal # OF COMPARTMENTS ❑ GREASETRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS DISTANCE To NEAREST: WELL I0 D� ft FOUNDATION ID, ft PROPERTY LINE 71 ft ❑3 LIFT STATION SIZE TYPE OF PUMP ElPKG TX PLANT L1 SAND OIL SEPARATOR (ENCLOSED SYSTEM) 1�YGl1WS W( LEACH LINES LEACHING CHAMBERS In}I #OF LINES LENGTH OF LINES fib" ft DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft ❑ FILTER BED WIDTH It LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft J 1 DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It / Lll SUMPS LZ / WIDTH -1]ft LENGTH I'W ft DEPTH 9 ft 1- DISTANCE TO NEAREST WELL 150 It FOUNDATION 10 ft PROPERTY LINE ft ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH It DISTANCE TO NEAREST WFI I It FOUNDATION ft PROPERTY LINE ft ❑ SEEPAGE PITS NUMBER WIDTH It DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION fl 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. DEPARTMENT 1VJSff ONLY Application Accepted By �� Date C Area Employee,D#— Final Inspection By Date l7j SPECIAL PERMIT - Approved by Character of Soil to Depth oV Ft: PIVSump Soil Character: COMMENTS �r�i.%�t'� S rZ T)Pv ___ PE SC Received Check#/ AmountPermit/ Invoice # Permit ID# Code INFO Cash Remitted ple Service RequAst # X13 �7 SF` 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14M 8 —NT ✓ED 2021 OUNTY TAL MENT