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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 rvuN-Mt-UNDAtSLt rhHMI r (;ALL ZUy y0J-/U-Y1 FOR INSPECTIONS EXPIRES 1` YEAR FROM DATE ISSUE] JOB ADDRESS i�� '/ /' CITY/ZIP CROSS STREET �^L^vriyy/^ LAI APN C)(p! 0 J0) 1 PARCEL SIZE OWNER NAME / * y 1 I/ 1 L" �' - . Ara'A ,t PHJO�NE ,�q OWNER ADDRESS 7J �2 1 ) �'y1 t / " I Ie CITY/STATE/ZIP .—,L- t7 J4,o %7 CONTRACTOR 1S �(�/IA A .'A A �. PHONE 1-04 CONTRACTOR ADDRESS _/ G�,� �� lN V CITY/STATE/ZIP nt:Iz-GAN CrQ �� n LICENSE ❑11C-42 ❑❑C-36 OTHER NUMBER f% EXPIRATION DATE WATER TABLE DEPTH: 13-D— NO ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # I F BUILDING PERMIT # LAND USE APPLICATION # TYPE OF WORK: Xj NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED /ALTERNATIVE ❑ REPLACEMENT ❑ OUT -OF -SERVICE SEPTIC SYSTEM ❑ DESTRUCTION INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: tit SEPTIC TANK ❑ GREASE TRAP ❑ LIFTSTATION TYPE/MFG -4/1r) / i, -4y o TYPE/MFG DISTANCE TO NEAREST: WELL SIZE TYPE OF PUMP CAPACITY D gal # OF COMPARTMENTSL CAPACITY gal # OF COMPARTMENTS ft FOUNDATION ft PROPERTY LINE ft . ❑ 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. SIGNED DATE l7 ✓.,� .% I DEPARTMENT USIE ONLY "'�R_Lj{J 7. Application Accepted By = Zi �� Date Area �G' Employee ID# N Final Inspection By ` DateY! 7407 ❑ SPECIAL PERMIT -Approved by Character of Soil to Depth of 3 Ft: PiUSump Soil Character: COMMENTS / v f.AA c r1. j, rjr PE Code LEACH LINES ❑ LEACHING CHAMBERS Permit/ Service Request # # OF LINES 3 LENGTH OF LINES / ft ► i7 —2321 DISTANCE TO NEAREST la WELL ft FOUNDATION ft PROPERTY LINE ft ❑ FILTER BED WIDTH ft LENGTH _ ft DEPTH a 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 NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft SEEPAGE PITS NUMBER .S�' WIDTH , ft DEPTH A.S ) ft DISTANCE TO NEAREST WELL 15-0 L ft FOUNDATION //) ►- ft PROPERTY LINE f 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. SIGNED DATE l7 ✓.,� .% I DEPARTMENT USIE ONLY "'�R_Lj{J 7. Application Accepted By = Zi �� Date Area �G' Employee ID# N Final Inspection By ` DateY! 7407 ❑ SPECIAL PERMIT -Approved by Character of Soil to Depth of 3 Ft: PiUSump Soil Character: COMMENTS / v f.AA c r1. j, rjr PE Code SC INFO Received heck#/ Amount Date B as Remitted Permit/ Service Request # Invoice # Permit ID# '1211 ► i7 —2321 5,Z1W 2z 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18