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I ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE -STOCKTON CA 95205 - (209) 468-3420 NON-KEFUNDA-BBL�E� 1'ERMI1 JOB ADDRESS - CROSS STREET •�/ V� ,•,1 1/Vj) Wejf1,1 Rd,.. _ APN 00 J a aO 1 O PARCEL SIZE � • �� OWNER NAME C/t�Nl>L -�1-1� hL� f� 1 - PHONE OWNER ADDRESS CITY/STATE/ZIP CONTRACTOR j6 es -t CaaMaxwell tk3ur-k-hyee, Inc. PHONE 20q. 3317. -7394 /-�f� CONTRACTOR ADDRESS / Y ax we l I V`I . �CITY/STATE/ZIP LOIN I CA g6aik) LICENSE _ C-42 C-36 OTHER A NUMBER Vi1 S EXPIRATION DATE 2L) 7-3 3 WATER TABLE DEPTH: It GEOGRAPHICAL INFORMATION: Coordinates X Y LY j Area `/ C PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # li SPECIAL PERMIT TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED /ALTERNATIVE ump Soll Character: REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION i INSTALLATION WILL SERVE: L7 RESIDENCE . COMMERCIAL OTHER (i )VI' E O Io. 1 I NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ----A 1 SEPTIC TANK TYPE/MFG PSL CAPACITY 2000 gal #OF COMPARTMENTS , ❑ GREASETRAP TYPE/MFG CAPACITY gal #OFCOMPARTMENTS DISTANCE TO NEAREST: WELL i SD ft FOUNDATION 10 + ft PROPERTY LINE 5t It ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) ❑ LEACH LINES LEACHING CHAMBERS # OF LINES LENGTH OF LINES ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft DISTANCE To NEAREST WELL ft FOUNDATION R PROPERTY LINE ft Gill" MOUNDED WIDTH ZZ•�O ft LENGTH IOD Il DEPTH ft DISTANCE TO NEAREST WELL 1°50+ ft FOUNDATION I1 ft PROPERTY LINE S -C ft ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ DISPOSALPONDS WIDTH it LENGTH It DEPTH It DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft DISTANCE TO NEAREST WELL ft 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. U 40 SIGNED HOLU ADVANCE NOTICE REQUIRED FOR INSPECTIOtIS - PLEASE CALL (209) 953-769 TITLE DATE 712a RFY&j jWT Ci;vzo JUL 2 8 2021 H o� PMENTq� T Y ARTMENT Application Accepted B EP RTMENT SE to LY j Area `/ C Employee ID#NA Final Inspection By Date li SPECIAL PERMIT - Approved by Character of Soil to Depth of 3 Ft: P U ump Soll Character: COMMENTS pelf PiP- IC'I03�%7 S r.L .11P -A SfDIC149 id I th V" r ilYIS Y0061, Pk1 r r- ch Ya -pm, bie., • (0c' I . le,irD-iv-s 2" caji a Part Ilfu�lnL' T Sy5-feY� __ PE SC Received Check#/ Amount Dat PermiU Invoice # Permit ID# Code INFO B Cash Remitted Service R est# 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14118