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t- pire• . ONSITE WASTEWATER TREATMENT SYSTEM PERMIT :SS3H00V 31IS SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 -(209) 468-3420 NON-REFUNDABLE PERMIT CALL (209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS ‘9,1e(;) h/A6174,/172 7- X? CITY/ZIP ..4)/Iii,f-,!%fl CROSS STREET AWE, /717 44" , OWNER NAME , S.:74/104Ke,/ > APN 177o 3 DO3 PHONE _c/9,e PARCEL SIZE i a L i OWNER ADDRESS CONTRACTOR Arliejt/12,1,41( A:44/10/./19 65- C CONTRACTOR ADDRESS CITY/STATE/ZIP PHONE CITY/STATE/ZIP r, *7;941 7:4 a9,5-,Zic LICENSE 0 EIC-42 0 EC-36 OTHER NUMBER g6277 EXPIRATION DATE WATER TABLE DEPTH: PO — )3D LI PERC TEST # ft GEOGRAPHICAL INFORMATION: Coordinates X BUILDING PERMIT # LAND USE APPLICATION # TYPE OF WORK: H. NEW INSTALLATION REPAIR/ADDITION I_ ENGINEER DESIGNED /ALTERNATIVE Li REPLACEMENT U OUT-OF-SERVICE SEPTIC SYSTEM H DESTRUCTION INSTALLATION WILL SERVE: X RESIDENCE LI COMMERCIAL 0 OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: CI SEPTIC TANK GREASE TRAP la LIFT STATION TYPE/MFG TYPE/MFG DISTANCE TO NEAREST: WELL SIZE TYPE OF PUMP CAPACITY gal # OF COMPARTMENTS CAPACITY gal # OF COMPARTMENTS ft FOUNDATION ft PROPERTY LINE ft PKG TX PLANT CI SAND OIL SEPARATOR (ENCLOSED SYSTEM) gd LEACH LINES H LEACHING CHAMBERS DISTANCE TO NEAREST WELL /496:711 CI FILTER BED WIDTH ft LENGTH DISTANCE TO NEAREST WELL ft FOUNDATION CI MOUNDED WIDTH ft LENGTH )41.. SUMPS WIDTH ft LENGTH /fri DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY INE ft ft DEPTH ib ft ft FOUNDATION ft PROPERTY LINE ft DISTANCE TO NEAREST WELL 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. # OF LINES / LENGTH OF LINES (4q) ft ft FOUNDATION ft PROPERTY LINE S.'1 ft ft DEPTH ft ft PROPERTY LINE ft ft DEPTH ft SIGNED MINI 6 M 48 HOU54DV NCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 ( TITLE e. - 1 rz e.• DATE 5 Q4 ft PAYME. RECFN _MO 1 21 41, • uNre 1" NEM 14 sALTH DEPA Roto,AF TAL SPlotDIAQUI \I DEPARTMENT US ONLY Application Accepted By 4ar Date Air Area 67 Employee ID# terK AfrAr COMMENTS Systeillhi J.E5-0c) co-nd I'?t Ii4e pjvfec Add cid* d‘a 41 I )-kf (of pie F )veid ps-sv arod ittly4-/S keep ;to h11/4511 5ra1mcf. PE Code SC INFO Received By Check#/ Cash Amount iRemitted Date Permit/ Service Request # Invoice # Permit ID# Hdl° ii-- V *IM 303 r.9t1/ 24 secop--1 110\38 l Character of Soil to D pth of 3 Ft: 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT Date 0 SPECIAL PERk/19- - Approved by Final Inspection By SA7IX 13 * ump Sell Character: 4/14/18