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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 IYON-KEFUNUA5LE I'LIHMAIT GALL (ZU&)JJJ-/b`J/ FOR INSPECTIONS tXPIRE5 T TEAR FROM DATE ISSUEI JOB ADDRESS O d O 15 W . ST. ma1 ► • CITY/ZIP y, Ug�&J-F&? % 9K-6 a I, CROSS STREET2 �/'TDN jzA AP OO I ` Z �0 REPAIR/ADDITION PARCEL SIZE o.44 OWNER NAME CRR -OLE P/IJNit LL PHONE ` —4" 03 t0V OWNER ADDRESS t'A% • 14/0 /GA O t -I 2 n• CITY/STATE/ZIP (I CA CONTRACTOR ^� G"V (II V '' _ (0 / -0-s-15- E O4 CrE O E#11VI (L0N r^C r'jT RL- PHONE Z ❑ CONTRACTOR ADDRESS 40, w, OlkIL -F-1. CITY/STATE/ZIP LD -DI CA- S'y`'�y LICENSE L C42 11',1 C-36 OTHER C E U NUMBER 2-15-1 EXPIRATION DATE 4` 3o Z Z WATER TABLE DEPTH: 10-7-0 ft GEOGRAPHICAL INFORMATION: Coordinates X Y )( PERC TEST # I I BUILDING PERMIT # LENGTH OF LINES ft LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION _, ENGINEER DESIGNED/ALTERNATIVE ❑ FILTER BED WIDTH REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: ❑ RESIDENCE J COMMERCIAL _' OTHER WELL NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPE/MFG CAPACITY gal # OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS ❑ SUMPS WIDTH DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) ❑ LEACH LINES LEACHING CHAMBERS # OF LINES LENGTH OF LINES ft aaa DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE R ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL it FOUNDATION ft PROPERTY LINE R ❑ SUMPS WIDTH ft LENGTH ft DEPTH It DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE ft ❑ DISPOSAL PONDS WIDTH ft LENGTH it DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH It DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE it 1 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. IN/ HOUR ADV E N TICE REQUIRED FR INSPECTIONS -PLEASE ALL (209)953-7697 SIGNED TITLE 10I20J . M Cr�DATE�- V2 Final Inspection By �j'h�t, �'( iSg24 A, --L Date - //(11 SPECIAL PERMIT -Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS :6 1 ✓� 1` Imo: nti�� J.��y, I ✓]I/ S1Q,2-1 - rkk PE Code SC Received heck INFO B Amount Remitted ate PermiU Invoice # Permit ID# S rvice Re est # aaa sa3 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18