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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 IVUN-1-IEFUNUABLE I'ERMI I``A-GALLLL (ZU`J) `JbJ-/b}// FOR INSPECTIONS tXPIREIS 1 YFAR FROM UATE ISSUE ✓ JOB ADDRESS 1316-0 � I v N Q c, Xl> CITY/ZIP L 0 0 1 -1 7;- If 0 CROSS STREETWA-R'N �y APN Olog-- OZO-33 PARCEL 1SIIZZ IE S'O0 A'f Q. OWNER NAME � `^JAPHONE(-1 OWNER ADDRESS S PI M I E CITY/STATE/ZIP CONTRACTOR LA V t- DAK- 6•E0EnNV 1e-aPjML- j T A L- PHONE 36`1 ` 03-1 S' CONTRACTOR ADDRESS 40, W' O%h<' AT- CITY/STATE/ZIP L-yt7l GA y,Sl4O LICENSE C42 _: C-36 OTHER C L' NUMBER 24571 EXPIRATION DATE — --LZ WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y -,G PERC TEST # I BUILDING PERMIT # It LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE ft FOUNDATION . REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: _ RESIDENCE COMMERCIAL OTHER It DEPTH NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EI. PLOYEES: ❑ SEPTIC TANK TYPE/MFG CAPACITY gal # OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS DISTANCE TO NEAREST DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE It ❑ LIFT STATION SIZE _ -- TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) ❑ LEACH LINES LEACHING CHAMBERS ft PROPERTY LINE It # OF LINES it DISTANCE TO NEAREST WELL ft DEPTH ft FOUNDATION ❑ FILTER BED WIDTH ft LENGTH ft It DEPTH ft DISTANCE TO NEAREST WELL ft DEPTH It FOUNDATION ❑ MOUNDED WIDTH ft LENGTH DISTANCE TO NEAREST WELL ft FOUNDATION ❑ SUMPS WIDTH ft LENGTH DISTANCE TO NEAREST WELL ft FOUNDATION ❑ DISPOSAL PONDS WIDTH ft LENGTH DISTANCE TO NEAREST WELL ft FOUNDATION ❑ SEEPAGE PITS NUMBER WIDTH DISTANCE TO NEAREST WELL ft FOUNDATION LENGTH OF LINES ft ft PROPERTY LINE It ft DEPTH it ft PROPERTY LINE It ft DEPTH ft ft PROPERTY LINE ft ft DEPTH ft ft PROPERTY LINE ft It DEPTH ft It PROPERTY LINE ft ft DEPTH ft ft PROPERTY LINE It 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. MINIMUM IfHDUR AQV4W NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL 209) 953-76197 SIGNEDA�f TITLE O2oJ • ►til ('o*j9-' DATE 9 - I ` Z COMMENTS PE SC Received Check#/ Amount ate Permit/ Invoice # Permit ID# Code INFO ash Rem' Service Request # 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18 iiiENT EIVED 10 2021 UIN COUNTY )NMENTAL EPARTMENT