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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 NUN-KErUNDABLE rERMIT ^ ^ (;ALL (ZUy)'J53-/6y/ FOR INSPECTIONS EXPIRES1 YEAR FROM DATE ISSUED JOB ADDRESS CITY/ZIP CROSS STREET APN07 7"35- V - 0 7 ^� VPARCEL SIZE OWNER NAME vV L L_, F PHONE '' OWNER ADDRESS I cl / \ 11�Y Y �1 (- CITY/STATE/ZIP �1 V� L�nl/ CONTRACTOR F /��J I�� 7��2�/\(J \,_ ` PHONE _20,j — �� — CONTRACTOR ADDRESS ( 1 I� CJS`<��\ CITYISTATE/ZIP "5 -V -)c LICENSE 110C-42 ❑IAC -36 OTHER NUMBER EXPIRATION DA WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # TYPE OF WORK: I NEW INSTALLATION [I REPAIR/ADDITION ❑ ENGINEER DESIG D /A TER1NN4�TIVE Ci REPLACEMENT ❑ OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION17e- INSTALLATION ( T INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPE/MFG ❑ GREASE TRAP TYPE/MFG CAPACITY CAPACITY DISTANCE TO NEAREST: WELL ft FOUNDATION _ ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT gal # OF COMPARTMENTS gal # OF COMPARTMENTS ft PROPERTY LINE ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) ❑ LEACH LINES ❑ LEACHING CHAMBERS Received Ehy Check#/ Cash #OF LINES Date I LENGTH OF LINES Invoice # DISTANCE TO NEAREST WELL e�7j ft FOUNDATION lj'2 ft PROPERTY LINE ❑ FILTER BED WIDTH ft LENGTH ft DEPTH DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ❑ MOUNDED WIDTH ft LENGTH ft DEPTH DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ❑ SUMPS WIDTH ft LENGTH ft DEPTH DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE 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. /VI //NIIY/VI I YO I7VVI� HUV YA+C IYV /IVC RC VIRC✓ rVR IIYJrCV / IV/Y a7 — /-LLh JL \I/9LL t:V� �././-/ �/ / SIGNED 1. 'V(j� -!' ` f % i� i TITLE L �' L7 �'� ( DATE % 1 2 / 112 DEPARTMENT U E QNLY Application Accepted ELy Date j Z/ Area Employee ID# Final Inspection By r c �� Date `0� p�� ❑ SPECIAL PERMIT -Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS ©,4*, A Cv'.iec-�- 740 c4& .WLaei- 0-0"-d �'�r c ft ft ft ft ft ft ft ft ft ft ft ft PE Code SC INFO Received Ehy Check#/ Cash Amount Remitted Date I Permit/ Service Request # Invoice # Permit ID# zzi e�7j lj'2 21 21 pfq2-3 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18