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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 L;ALL (ZUY) VUK 1Ns1-tc11U1VS CAr,IKCD I r MAIN I-KVIVI vAI r- IAJUCI JOB ADDRESS 1 J� w� ly �4ts ECD �L kiy� CITY/ZIP L.G 5— ctI�J !� Gi¢ 95-2-0 yy�/I CROSS STREET � 11,,E i APN 1/719303 iS PARCEL SIZE 1 1 OWNER NAME/y✓S y%i(�GIoJ� Z ` PHONE -/6 � 71Z-/ � OWNER ADDRESS�7S / ft / CITY/STATE/ZIP CONTRACTOR z66Q e174,/ �ll�! PHONE 20!2 / -7 S -Gf�� FOUNDATION ft PROPERTY LINE CONTRACTOR ADDRESS y /A �i / t�vA/rJ CITY/STATE/ZIP,��r/�iL� �9S zGS LICENSE ❑❑C-42 ❑❑C-36 OTHER NUMBER JY"/Z 7� EXPIRATION DATE I I I goo WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X ❑ PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # TYPE OF WORK: C NEW INSTALLATION I REPAIR/ADDITION ❑ ENGINEER D'. Y NED/ALTERNATIVE ❑ REPLACEMENT I OUT -OF -SERVICE SEPTIC SYSTEM k DESTRUCTION6' 11lV INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ ❑ ❑ SEPTIC TANK GREASE TRAP LIFT STATION TYPE/MFG TYPE/MFG DISTANCE TO NEAREST: WELL SIZE TYPE OF PUMP ft CAPACITY CAPACITY FOUNDATION ❑ PKG TX PLANT ❑ gal # OF COMPARTMENTS gal # OF COMPARTMENTS ft PROPERTY LINE SAND OIL SEPARATOR (ENCLOSED SYSTEM) ft ❑ LEACH LINES I ! LEACHING CHAMBERS c GC 4 Z # OF LINES LENGTH OF LINES ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ FILTER BED WIDTH ft LENGTH It 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 ft DISTANCE TO NEAREST WELL It 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. DEPARTMENTUS ONLY Application Accepted B Date D % D Area "/ Employee ID#_�� Final Inspection By Date ❑ SPECIAL PERMIT -Approved by Character of Soil to Depth of 3 Ft: Pit/ ump Soil Character: COMMENTS Dewy -of AouSP_ Contydlo,,) ;t� Sewr1. Junk odder Cloyi-vi V, PE Code SC INFO Received By Check#/ Cash Amount Remitted ate Permit/ Service Request # Invoice # Permit ID# 07S- c GC 4 Z 42-01 ; I I In i ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18 T