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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZE LTON AVENUE -STOCKTON CA 95205 -(209) 468-3420 NON-REFUNDABLE PERMIT CALL (209) 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS /�ll.�°Lc�L lC�!/t.� /c' oad CITY/ZIP CROSS STREET r U 11 Hr 14 L✓ APN � � ,1 �rj O t7/ � %r1PARCEL1SIIZE OWNER NAME �/ CnVIejI4 �1 n )moi /� PHONE / C' C3') &! jct�/ 04 OWNER ADDRESS 115'('o i'-.' L ol%`ey C I9 CITY/STATE/ZIP CONTRACTOR c) WI1'e r PHONE CONTRACTOR ADDRESS LICENSE ._ C-42 ❑_C-36 OTHER CITY/STATE/ZIP NUMBER EXPIRATION DATE WATER TABLE DEPTH: 9 O ft GEOGRAPHICAL INFORMATION: Coordinates X Y PERC TEST # BUILDING PERMIT #-J) Dd LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED /ALTERNATIVE REPLACEMENT OUT -0F -SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL FII OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: 3 NUMBER OF EMPLOYEES: SEPTIC TANK C (1h vH TYPE/MFG L CAPACITY J ) L) Ugal # OF COMPARTMENTS r ❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS ❑1,.,,11LEACH LINES DISTANCE TO NEAREST: WELL M -�� ; ft FOUNDATION ft PROPERTY LINE t 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. SIGNED / k, V![ IIYJrCI. l IVIYJ - rLC/iJC l.liLL I LVy/ TITLE DATE DEPARTMENT USE ONLY Application Accepted Date 6 d d I Area 5 C Employee ID# Final Inspection By_ t Date V ❑ SPECIAL PERMIT -Approved by Character of Soil to Depth of 3 Ft: 0itISum Soil Character: COMMENTS SFR/ TI Bf PE Code SC INFO Received Check#/ Amount By Cash Remitted Date Permit/ Invoice# PermitID# Service Request # L 11 17 S� 2L ❑1,.,,11LEACH LINES LEACHING CHAMBERS # OF LINES _ LENGTH OF LINES NO ft DISTANCE TO NEAREST WELL E 6 ft FOUNDATION ft PROPERTY LINE NGC"J ft ❑ 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 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. SIGNED / k, V![ IIYJrCI. l IVIYJ - rLC/iJC l.liLL I LVy/ TITLE DATE DEPARTMENT USE ONLY Application Accepted Date 6 d d I Area 5 C Employee ID# Final Inspection By_ t Date V ❑ SPECIAL PERMIT -Approved by Character of Soil to Depth of 3 Ft: 0itISum Soil Character: COMMENTS SFR/ TI Bf PE Code SC INFO Received Check#/ Amount By Cash Remitted Date Permit/ Invoice# PermitID# Service Request # L 11 17 S� 2L 42-01 I �%n I�/ I I ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18 T