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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 GALL LUyJ 9DJ-/6y/ FOR INSPECTIONS EXPIRES l YEAR FROM UATE ISSUEI JOB ADDRESS C CITY/ZIP �7 ✓Ii^ I G,� /J 7 CROSS STREET e -I �� d APN I (/ J --30 Q — -26 PARCEL SIZE (� OWNER NAME if�C�j-Lr_ �K�� PHONE OWNER ADDRESS 0 1&:'l S49A L -/v/- - CITY/STATE/ZIP CONTRACTOR t�Z2 $�G/_( 0,t— _<-e PHONE 031.4,C-1-4 ,��/�% 6� CONTRACTOR ADDRESS 6 6 A ^ & SO CITY/STATE/ZIP [/' 1.4 ,�Co1-4 LICENSE ❑❑C-42 ❑CIC -36 OTHER m4= NUMBER bn8!�;SLExPIRATIONDATE WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT #LAND USE APPLICATION # TYPE OF WORK:?— NEW INSTALLATION ❑ REPAIR/ADDITION EI ENGINEER DESIGNED /ALTERNATIVE E REPLACEMENT ❑ OUT -OF -SERVICE SEPTIC SYSTEM ❑ DESTRUCTION INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTHER I�UMBER OF LIVING UNITS: NUMBER OF BEDROOMS: _�! NUMBER OF EMPLOYEES: SEPTIC TANK TYPE/MFG �d-L CAPACITY p) Zj gal # OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS DISTANCE TO NEAREST: WELLTQnd— ft FOUNDATION ISI ft PROPERTY LINE '�iS I ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) LEACH LINES ❑ LEACHING CHAMBERS I # OF LINES _� LENGTH OF LINES ft DISTANCE TO NEAREST WELL ft FOUNDATIONSIL I ft PROPERTY LINE 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 ❑ DIS SAL PONDS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft SEEPAGE PITS NUMBER 1 WIDTH Lt.) I I ft DEPTH Z,5 I ft DISTANCE TO NEAREST WELL I _S�ft FOUNDATION :7 15' ft PROPERTY LINE dl 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 r� TITLE `� 7�1 4 SOC- DATE % (5 D PARTMENT USEIONLY G, Application Accepted Date � Area Employee ID# .t. Final Inspection By Date ❑ SPE IAL PERMIT -Approved by Character of Soil to Depth of 3 Ft: I Pitjs6mp oil Character: COMMENTS 7�J/(, Af PE Code SC INFO Receive y Check#/ Amount Cash Remitte Date Permit/ Service Request # Invoice # Permit ID# l l I� � 21 500 gy 322 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18 r