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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-KEFUNDApBLLEPE/ RMS IIT (;ALL ZU.9.953-16.91 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUE JOB ADDRESS I 914({ / 6v 11/r /moo-l(/CITY/ZIP CITY/ZIP - d j cQbl,% 0 f CROSS STREET�/,,.I TYPE/MFG �/ APN. I I o 6 PARCEL SIZE C, OWNER NAME ._l04AI ,, 1,, �-`. IK. (9"19s.-7 FOUNDATION PHONE OWNER ADDRESS o FD `-�,//!� CITY/$TATE/ZIP 1 i� V(%�F�1�J�E�� 1S /r7� ,,P, CONTRACTOR r't fl ` q I /-.A �.n Ct/`^� eo 0.606 • PHONE % �c - �/� / CONTRACTOR ADDRESS 3 �-7`� �/ I'}' lJ� �'�Qe✓) I p /gffe D�/ CITY/STATE/ZIP /�) �y J'0�� , (, 4 LICENSE ❑ X-42 ❑ FIC -36 OTHER NUMBER 7 O �J EXPIRATION DATE DISTANCE TO NEAREST WATER TABLE DEPTH: (��-, ft GEOGRAPHICAL INFORMATION: Coordinates X Y PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION _ ENGINEER DESIGNED /ALTERNATIVE REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: X RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: LTJ 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. Final Inspection By y Date I �_�� _ JPEOIAL PERMIT -Approved by Character of Soil to D pth of 3 Ft: Pit/Sump Soil Character: COMMENTS S164e',1'1'7 -ynkt+u Yt- �Ii:L1S�Er PE SC LEACH LINES LEACHING CHAMBERS # of LINES l ❑ SEPTIC TANK TYPE/MFG 1�'A 56.99 / oc-r4e, CAPACITY gal # OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG �/ CAPACITY gal # OF COMPARTMENTS FILTER BED DISTANCE TO NEAREST: WELL ft FOUNDATION 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. Final Inspection By y Date I �_�� _ JPEOIAL PERMIT -Approved by Character of Soil to D pth of 3 Ft: Pit/Sump Soil Character: COMMENTS S164e',1'1'7 -ynkt+u Yt- �Ii:L1S�Er PE SC LEACH LINES LEACHING CHAMBERS # of LINES l LENGTH OF LINES "�'O ft Code INFO B ash DISTANCE TO NEAREST WELL POO n ft FOUNDATION / O ft PROPERTY LINE ❑ 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 DISTANCE TO AREST WELL ft FOUNDATION ft PROPERTY LINE ft SEEPAGE PITS NUMBER ) WIDTH -z ft DEPTH C7 S ft DISTANCE TO NEAREST WELL 1900 ft FOUNDATION 30 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. Final Inspection By y Date I �_�� _ JPEOIAL PERMIT -Approved by Character of Soil to D pth of 3 Ft: Pit/Sump Soil Character: COMMENTS S164e',1'1'7 -ynkt+u Yt- �Ii:L1S�Er PE SC Received Che / Amount ate Permit/ Invoice # Permit ID# Code INFO B ash Remitted Service Request # H310 lis 0AIX tqs Oddi �� 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18