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Y ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN CouRr 'Y 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 i oguips�l,n �t,-f w Yc 12 CI�TY//Z,IIP/ CROSS STREET -U((, / N APN PARCEL SIZE � ` OWNER NAME ar/ q 0(2- ✓ ` sus 12 101 /"2Z PHONE OWNER ADDRESS CITY/STATE/ZIP CONTRACTOR if YW 1 U4r`nI N ci jh C_ PHONE -;`0�— 3c,$ L-5' / CONTRACTOR ADDRESS 3 �' j(e ' `l `�- V': CITYISTATE/ZIP J C �F '�� C4 LICENSE 0(7C-42 ❑❑C-36 OTHER NUMBER 7S `��'7S EXPIRATION DATE 9 �? WATER TABLE DEPTH: 1 l ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT # l0`? Zi5 5 LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION ❑ REPAIR/ADDITION f_7 ENGINEER DESIGNED /ALTERNATIVE DISTANCE TO NEAREST WELL wQ /'T( ❑ REPLACEMENT ❑ OUT -OF -SERVICE SEPTIC SYSTEM ❑ DESTRUCTION LINSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: "I SEPTIC TANK / 7r� TYPE/MFG C 1�1�1� 3 C CAPACITY /pc.iL/) �7 gal # OF COMPARTMENTS o'er ❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS ft PROPERTY LINE DISTANCE TO NEAREST: WELL �%DO � ft FOUNDATION 3G � / ft PROPERTY LINE 7 O 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. SIGNED Application Accepted By Final Inspection By Character of Soil tto ept f 3 COMMENTS r F Y -C' --I TITLE DATE l� - lR ^ c- EPARTMENT U E ONLYfrl Date ( z` Z1 Area "! Employee ID# Date ❑ SPECIAL PERMIIT -Approved by NT Pit/Sump Soil Character: PAYME W r 1 q- // / �_� mp'. 59,00 S- 3 6 3 i RECEIVED PE Code LEACH LINES ❑ LEACHING CHAMBERS # OF LINES 3% LENGTH OF LINES ft / I lfi DISTANCE TO NEAREST WELL wQ /'T( ft FOUNDATION Ile) ' ft PROPERTY LINE rS7 / 0 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 L SEEPAGE PITS DISTANCE TO NEAREST WELL NUMBER WIDTH ft FOUNDATION 3�0 ft ft PROPERTY LINE DEPTH e5;)5 ft ft DISTANCE TO NEAREST WELL CPW /'f— ft FOUNDATION %O ft PROPERTY LINE r 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. SIGNED Application Accepted By Final Inspection By Character of Soil tto ept f 3 COMMENTS r F Y -C' --I TITLE DATE l� - lR ^ c- EPARTMENT U E ONLYfrl Date ( z` Z1 Area "! Employee ID# Date ❑ SPECIAL PERMIIT -Approved by NT Pit/Sump Soil Character: PAYME W r 1 q- // / �_� mp'. 59,00 S- 3 6 3 i RECEIVED PE Code SC Received Check#/ Amount INFO y zAao --Remitted Date Permit/ Service Request # Invoice # PermFiNyWONM HEN TH DE z�1 I lfi it i 2 � 2021 COUNTY =NTAL RTMENT 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18