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fig ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 NON-KEFUNDABLE PERMIT GAL ZUyJ 90J-10,9/ FOR INSPECTIONS LXPIRESe"I YEAR FROM UATE ISSUED JOB ADDRESS an "vii.�f —L 5 ��-n �1 CITY/ZIP CGfi"y tS.r-tt T (' IAT CROSS STREET ) ( APN / % :3 a:q Z PARCEL SIZE ft FOUNDATIONS + OWNER NAME (,✓�G) I!^IO�G L, <Illl L, �'�(,� �1�avTtL�'f PHONE ft DEPTH ft �j ��i.� OWNER ADDRESS-CITY/STATE/ZIP WELL ft I� iW��/ • w/ CONTRACTOR I :S 6-,cK La JY.- _cei /� PHONE L4 ft LENGTH CONTRACTOR ADDRESS fJ(� �)(�� �a�i CITY/STATE/ZIP LICENSE ❑❑C-42 ❑GC -36 OTHER NUMBER EXPIRATIONDATE �� go 7 WATER TABLE DEPTH: J ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # TYPE OF WORK: C:i NEW INSTALLATION REPAIR/ADDITION ❑ ENGINEER DESK ❑ REPLACEMENT ❑ OUT -0F -SERVICE SEPTIC SYSTEM ❑ DESTRUCTION D /ALTERNATIVE INSTALLATION WILL SERVE: &-RESIDENCE ElCOMMERCIAL -J ❑ OTHER NUMBER OF LIVING UNITS: ✓ , NUMBER OF BEDROOMS: J NUMBER OF EMPLOYEES: ❑ SEPTIC TANK ❑ GREASE TRAP ❑ LIFT STATION TYPE/MFG TYPE/MFG DISTANCE TO NEAREST: WELL SIZE TYPE OF PUMP ft CAPACITY gal # OF COMPARTMENTS CAPACITY gal # OF COMPARTMENTS FOUNDATION ft PROPERTY LINE ft ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) Ul-LLINES ❑ LEACHING CHAMBERS Permit/ Service Request # # OF LINES �_ LENGTH OF LINES (riC1/ ft DISTANCE TO NEAREST WELL W1 ft FOUNDATIONS + ft 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 ❑ 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 ft FOUNDATION ft PROPERTY LINE ft [ 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 I N,1 TITLE_ _ C DATE If (S ISI Nr WA of DEPARTMENTUS ONLY Application Accepted By - U Date JJ /L/ i Area Employee ID# Final Inspection By Ul Date 161�� 2 ❑ SPECIAL PERMIT -Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS Fn ))VI!� sj,�5feYM ExisiinG bnn Jb�ey✓�oih l2Qe��r �� ni""n PE Code SC INFO Received B Check Amount Remitted ate Permit/ Service Request # Invoice # Permit ID# its- Oc7 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18