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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SA,N 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 c < L CITY/ZIP 'E CROSS STREET J�OCXJ _ APN�z 7- ✓dd —3 PARCEL SIZE � OWNER NAME Igti IC�D� \ 1 G/ lL 1C� V (/ PHONE 2C, q Ll Cf. � C�7� ( I OWNER ADDRESS 10,170 IC - l I I I ley 1� C^i� CITY/STATE/ZIP 1% ((; w o ( C T \ CA _) �- _e U CONTRACTOR W I* PHONE CONTRACTOR ADDRESS CITY/STATE/ZIP LICENSE 11❑C-42 110C-36 OTHER NUMBER EXPIRATION DATE WATER TABLE DEPTH: ft GEOGRAPHICAL INFO M TION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT # _ LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ❑ ENGINEER DESIGNED /ALTERNATIVE REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM ❑ DESTRUCTION INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: SEPTIC TANK TYPE/MFG CAPACITY gal # OF COMPARTMENTS !i ❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE 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. SIG �D /PAR TME T 04 Application Accepted B Date Area Employee ID#�. Final Inspection By . KI, Date Z ❑ SPECIAL P RMIT -Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS � f4 a PE ode SC INFO Received 15 Date LEACH LINES CI LEACHING CHAMBERS Permit ID# # OF LINES LENGTH OF LINES ft DISTANCE TO NEAREST WELL_�6b �'-t ft /S FOUNDATION 11`I'f ft PROPERTY LINE > ft ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft _Nw__ w I 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 PROPERTYVNE ft -,/Cr SEEPAGE PITS NUMBER - L WIDTH L�'2/t 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. SIG �D /PAR TME T 04 Application Accepted B Date Area Employee ID#�. Final Inspection By . KI, Date Z ❑ SPECIAL P RMIT -Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS � f4 a PE ode SC INFO Received Check#/ Amount Cash Remitted - — Date Permit/ Service Request # Invoice # Permit ID# 4LI I 4 3P �1 U �' ��- _Nw__ w I 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18 v v z U.