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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 NON-KEFUNDAB^LE GALL (ZU9) 9b(J-1691 FOR INSPECTIONS I YEAR FROM UATE ISSUEI JOB ADDRESS �Pjj��ERMIT &1734 9' &1 7 3 4 !t r � �-T I � CITTY//ZI^P� VQ J,t/XPIRES l AGN &all h^ S ; (,It— fi CROSS STREET CROSS Cr, i'tLa � APN 0 PARCEL SIZE /� 2, -?t> OWNER NAME FOUNDATION �C ft PROPERTY LINE lG'C I ft ❑ FILTER BED j?� U [� {i�Y 7-03- 03-CITY/STATE/ZIP ft / jPHHONE OWNER ADDRESS / DISTANCE TO NEAREST WELL ft FOUNDATION CONTRACTOR �-'Ql�i"� W �� Iley PHONE WIDTH ft LENGTH ft DEPTH ft CONTRACTOR ADDRESS LICENSE D )�-42 ❑ C-36 OTHER CITY/STATE/ZIP NUMBER `%5-9i'e1/S EXPIRATION DATE WATER TABLE DEPTH: `y ft GEOGRAPHICAL INFORMATION: Coordinates X Y C PERC TEST # BUILDING PERMIT #_,d 0 ' y 1 LAND USE APPLICATION # TYPE OF WORK: �' NE w INSTALLATION REPAIR/ADDITION I i ENGINEER DESIGNED /ALTERNATIVE REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM 1 1 DESTRUCTION INSTALLATION WILL SERVE: ]j RESIDENCE C COMMERCIAL J^f C OTHER NUMBER OF LIVING UNITS: I NUMBER OF BEDROOMS: (7' NUMBER OF EMPLOYEES: ❑ ❑ SEPTIC TANK GREASE TRAP LIFT STATION TYPE/MFG �SaiC/(E.� /�� L TYPE/MFG DISTANCE TO NEAREST: WELL c,'�L 0 ft SIZE TYPE OF PUMP CAPACITY U gal # OF COMPARTMENTS CAPACITY gal # OF COMPARTMENTS FOUNDATION l� ft PROPERTY LINE SCG' ft ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) Permit] Invoice # Permit ID# LEACH LINES LEACHING CHAMBERS # OF LINES LENGTH OF LINES S S ft Service Request # X 11 DISTANCE TO NEAREST WELL FOUNDATION �C ft PROPERTY LINE lG'C I 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 SEEPAGE PITS DISTANCE TO NEAREST WELL ft NUMBER r WIDTH 7 z FOUNDATION /+ ft ft PROPERTY LINE ft DEPTH r2-5 / ft DISTANCE TO NEAREST WELL �� ' ft p FOUNDATION UCS ft PROPERTY LINE �C L� - 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. Final Inspection By );". S cc1 'I)2z Date �1%y/2 ( C SPECIAL PERMIT -Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS- -, 1�%� �i F r PE SC Received Ceck#/ Amount at Permit] Invoice # Permit ID# Code INFO By Cash Remitted Service Request # X 11 t 17 214E f S B'? ( 3S - 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18