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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-MEFUNDABLE PE �RMIT (:ALL LUY ybJ-/tiy/ FOR INSPECTIONS EXPIRRES� 1 YEAR FROM DATE ISSUE] ( JOB ADDRESS 71 I l I y, ) CIITYJ/ZIP t�r r / C• T CROSS STREET ) C �D � O / / ,� APN LJ I �b v PARCEL SIZE L v OWNER NAME Me 7WR, K RIO II DIY � V PHONE � OWNER ADDRESS /jl�i 1 Dc,1 S (/, AVP C_ / CITY/STATE/ZIPIJ �Li)(-j o/ CONTRACTOR YY` t(�¢ (-SL- A a a-� de !' PHONE L 57, '—��Off% CONTRACTOR ADDRESSV'Y�SC L�`� V CITY/STATE/ZIP !/I/jc✓l/� Qcr} , [.�� LICENSE ❑.-C-42 III -IC -36 OTHER NUMBER XPI RATION DATE �nci1 WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y C PERC TEST # BUILDING PERMIT #,--- LAND USE APPLICATION ## TYPE OF WORK:l W INSTALLATION REPAIR/ADDITION I ENGINEER DESIGNED //ALTERNATIVE REPLACEMENT k' 3 1 Qe-S OUT -OF -SERVICE SEPTIC SYSTEM 4'T DESTRUCTION �G111 {IG INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL G_I VJ ` C OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: GIG/ W Jt NUMBER OF EMPLOYEES: 7 / e3SEPTIC TANK TYPE/MFG-L CAPACITY h PW N gal # OF COMPARTMENTS_ ❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS WIDTH DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) /I I U LEACH LINES LEACHING CHAMBERS # OF LINESW-jLENGTH OF LINES �� ft Date Permit/'Invoice # Permit ID# DISTANCE TO NEAREST WELL I Col- ft FOUNDATION ((S 1 ft PROPERTY LINE ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft l 2 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 WELLft FOUNDATIONft PROPERTY LINE ft tr SEEPAGE PITS NUMBER ��ll�� WIDTH '"fes/ 7.4 ( ft DEPTH DISTANCE TO NEAREST WELL ft FOUNDATION �(� ft PROPERTY LINE )6' 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. SIGNED I z /1ja�� TITLE (f�64 If [' et c c DATE Jam' 1Il—cl Application Accepted By �— 1" Z�0 — Date E ? Area 4 �% Employee ID# r� Final Inspection By ;i/I c'. S i �e�L:. Iwo `L Date (l (Z -2 C SPECIAL PERMIT - Approved by Character of Soil to Depth of 3 Ft: PiVSump Soil Character: COMMENTS R d,),- ily,4 s -V<< PM (,,- hum. Pa'pGi 17sivY]• I� i h� aC��{LY1t_ _be jDL7� PE SC Received heck#/ Ambunt Date Permit/'Invoice # Permit ID# Code INFO B as Remitted Service R nest # Malo FIs a D x'300 l 2 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18 Z, 4 M,