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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-REFUNDABLE PERMIT �1� GALL (Z/Uy) Ub3-/6y/ FOR INSPECTIONS �f LXPIRES 'I YEAR FROM DATE ISSUE JOB ADDRESS S `� j o� ///D✓I e�i� LrtJ CITY/ZIP CROSS STREET APN Dom-/ PARCEL SIZE OWNER NAME ��J/�J�T/l�J�r.t� G'1/J ��-� PHONE OWNER ADDRESS CITY/STATE/ZIP CONTRACTOR e�"Z/ J JV/y�l , � �Ci / PHONE 7V 'q- -5 %00/ CONTRACTOR ADDRESS %7fv 6/t/ J�yJ�(= %�� CITY/STATE/ZIP LICENSE ❑kt-42 ❑❑C-36 OTHER NUMBER 7S�/d!-� EXPIRATIONDATEO5�/_/;7.3 WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION ❑ PERC TEST # BUILDING PERMIT # TYPE OF WORK: ❑ NEW INSTALLATION REPAIR/AD' Coordinates X Y LAND USE APPLICATION # IN ❑ ENGINEER DESK ❑ REPLACEMENT ❑ OUT -OF -SERVICE SEPTIC SYSTEM ❑ DESTRUCTION INSTALLATION WILL SERVE: P� RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: l NUMBER OF BEDROOMS: 7 NUMBER OF EMPLOYEES: ASEPTIC TANK TYPE/MFG ❑ GREASE TRAP TYPE/MFG z DISTANCE TO NEAREST: WELL ❑ LIFT STATION SIZE TYPE OF PUMP TERNATIVE CAPACITY e�GG16 gal # OF COMPARTMENTS CAPACITY gal # OF COMPARTMENTS ft FOUNDATION ft PROPERTY LINE ft ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) �- LEACH LINES ❑ LEACHING CHAMBERS # OF LINES Z LENGTH OF LINES yD s ft hec Cash Amount Remitted DISTANCE TO NEAREST WELL /Sy ft y FOUNDATION / S ft PROPERTY LINE 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 �"}c' 7-19 ft DEPTH �I ft ` DISTANCE TO NEAREST WELL y 0 + ft FOUNDATION f 014 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 _ w 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. Application Accepted By Final Inspection By Character of Soil to Depth of 3 Ft: COMMENTS-rilee?f . !NL I Area A 0-76u ❑ SPE Pit/Sump Soil Character: Employee ID# PERMIT - Approved by PE Code SC INFO Received By hec Cash Amount Remitted ate Permit/ Service R uest # Invoice # Permit ID# oo 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18