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I ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 NON-REFUNDABLE PERMIT SEPTIC TANK CALL (209) 953-7697 FOR INSPECTIONS 1 YEAR FROM DATE ISSUEI JOB ADDRESS 5016- -}� T�Qe;Arf(z ��E/XPIRES L -r, —CITY/ZIP(y, �4C/�TL--i, / 624- -1 P CROSS STREET �egle- INFO By APN O 8S - �3 00 ? PARCEL SIZE 1 70 OWNER NAME 13eCk�iJI ❑ y / �Gy�) L t]LNP I 3 S�yc e ��` PHONE SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) OWNER ADDRESS n l l LEACH LINES CITY/STATE/ZIP # OF LINES LENGTH OF LINESLf0 ft / CONTRACTOR I.CVI�i V `i I �y C PHONE A- FOUNDATION IQ ft PROPERTY LINES ft 2I t� CONTRACTOR ADDRESS i FILTER BED (� �E� ` CITY/STATE/ZIP ft DEPTH ft LICENSE ❑AC -42 ❑[ IC -36 OTHER NUMBER TS��`/ 51 EXPIRATION DATE FOUNDATION ft PROPERTY LINE ft WATER TABLE DEPTH: 60-70 ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # TYPE OF WORK: i NEW INSTALLATION X REPAIR/ADDITION ❑ ENGINEER DESIGNED /ALTERNATIVE Ii REPLACEMENT 11 OUT -0F -SERVICE SEPTIC SYSTEM DESTRUCTION Sep i L tC vik INSTALLATION WILL SERVE: / RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: l I NUMBER OF BEDROOMS: (4 ) _ NUMBER OF EMPLOYEES: J� SEPTIC TANK TYPE/MFG Cd °lack- //") t CAPACITY �c(� 0 gal # OF COMPARTMENTS r� '❑` GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS INFO By SA DISTANCE TO NEAREST: WELL f ubh C ft FOUNDATION ft PROPERTY LINE 15 ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) I I s LEACH LINES ❑ LEACHING CHAMBERS # OF LINES LENGTH OF LINESLf0 ft �• k ;331 DISTANCE TO NEAREST WELL W C ft FOUNDATION IQ ft PROPERTY LINES 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 DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft SEEPAGE PITS NUMBER WIDTH ft DEPTH �J� ft DISTANCE TO NEAREST WELL fVI& C ft FOUNDATION /O ft PROPERTY LINE D 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 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 SIGNED 22�t!Q !gx TITLE Gyct�"it/� DATE 110 'I/- v2/ DEPARTMENT U E ONLY Application Accepted By z— Date_ Area Employee ID# Final Inspection By Date 2, ❑ SPECIAL PERMIT -Approved by rharartar of Snil to r)enth of 3 Ft it/Sumo Soil Character: PE SC Received Che #/ Amount t Permit/ Invoice # Permit ID# Code INFO By SA Remitted Service Request # q) I J I I s 3 (D �• k ;331 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18 T y a 0 d n