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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-KEFUNDABLE PERMIT/J n GALf L (ZUY) Yb -Ibblf FOR INSPECTIONS tXPIRES 'I YEAR FROM UATE ISSUE JOB ADDRESS ;l"/A/l7 r22? r n C � ii �+'1f �� ac -1 CITY/ZIP E4S 5_ZZ- CROSS STREET APN �jPARCEL �jSIZE OWNER NAME 1,eo LAI .4 PHONE Vq�?J!14133 4133 OWNER ADDRESS C1-7 L (` d CITY/STATEIZIIP C JE-,4A�nJC7--7 CONTRACTOR CONTRACTOR 6jA-e _ PHONE &q- z 7O ~ -6,6 CONTRACTOR ADDRESS LICENSE ❑ DC -42 ❑ DC -36 OTHER CITY/STATE/ZIP NUMBER EXPIRATION DA WATER TABLE DEPTH: Over )S-0 ft GEOGRAPHICAL INFORMATION IV2 ❑ PERC TEST # BUILDING PERMIT #ItD TYPE OF WORK: X NEW INSTALLATION r.1 REPAIR/ADI Coordinates X LAND USE APPLICATION # iN D ENGINEER DE: D REPLACEMENT D OUT -OF -SERVICE SEPTIC SYSTEM ❑ DESTRUCTION Y TERNATIVE INSTALLATION WILL SERVE: '`,gr-' RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: �L NUMBER OF BEDROOMS: %i NUMBER OF EMPLOYEES: Ino {i C SEPTIC TANK TYPE/MFG �(w `�.yL� C� / P dr L&,eCaCAPACITY lZ iV gal # OF COMPARTMENTS 2- ❑ GREASE TRAP CAPACITY gal # OF COMPARTMENTS TYPE/MFG�11 Amount Remitted AA 1 l DISTANCE TO NEAREST: WELL `�V ft FOUNDATION (v ft PROPERTY LINE 2f,,-7 ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) LEACH LINES ❑ LEACHING CHAMBERS # OF LINES _ LENGTH OF LINES S-5 ft \ DISTANCE TO NEAREST WELL /'s6 ft FOUNDATION ft PROPERTY LINE 2!� ( ft ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft 9 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 NUMBERy WIDTH H7 11 ft DEPTH ft -7 DISTANCE TO NEAREST WELL 1S6 ft FOUNDATION `o T 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. MINIMUM 41 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL 209 953-7x69 7 j�� SIGNED/'/ y %Q � %ONS TITLe&10761*2 DATE ZC� z �DEPARTMENT USE ONLY Application Accepted By �� Date O d �f d Area -�" Employee ID# L Final Inspection By ��/1i oC/) Date 1%L��20 ZZ ❑ SPECIAL PERMIT -Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS _ c:CW40 L nJ dwe )W4 'f,F>- PE Code SC INFO Received B Check#/ Casb Amount Remitted Date Permit/ Service Request # Invoice # Permit ID# ai 1 1I SSL 9 & ,CC V 42-01 ��_,6w.4 J�,� n �j / v✓ ��7 � � ` ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18 I)j% . �f ` / 1 T n Y O 0 M