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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 F4UN-rttYUNUAbLE rEHMIT (;ALL ZUY &4D J -/Gy/ FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUEI JOB ADDRESS 32-2ZY- F- - �W (T716S n\/ Q-� CRY/ZIP_ A- I rrv-% 17 O , S -2-Z C G CROSS STREET ` /r� � L- Wn� (- AS�FF/ �/A7 APN OO S- - ' 4 S -41 r tPAARC-E7L SIZE 3. o / � r OWNER NAME �U ITEIV E ✓Nr 1 VZ L- II /�PHOONNE�,t` 4c)-?. -1313 •7 OWNER ADDRESS �� p,�O 1D ` P - T> • CITY/STATE/ZIP F , `• •1�Y► 1 f o c A 1 Y -2`y CONTRACTOR L,(y t O t \ � C-6 b eN V(A-01VV (1 f11- PHONE 3 69 ` � >! � CONTRACTOR ADDRESS Ty -1 t [d kIG- S F • CITY/STATE21P I -Ob ( CA Ci r 2L40 LICENSE L I..'C-42 L1 ;C-36 OTHER C `� NUMBER 2(� ( EXPIRATION DATE t -�y -I-2 WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION 0 REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE _ REPLACEMENT EI OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPE/MFG CAPACITY gal # OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP O PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) ❑ LEACH LINES LEACHING CHAMBERS # OF LINES LENGTH OF LINES ft DISTANCE To NEAREST WELL ft FOUNDATION 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 It DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH It 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 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. IMM0 11 ADVAN E NOTICE RE IRED FOR INSPECTIONS -PLEASE L 2 SIGNED '�-� C� TITLE /'f3 -0-J 01 Ci 1? DATE �� `- L H •- �' RAwpN. ; nsa, _. R qa ro9lw Yl � t I J} pm., 4 i � PaF.CEL < S C2 { 7SRGEi � F• ta,••w+ra RD N y��pp/4iu. RN.li-Iwr ➢MMR D44rpt �y.��`'�� � a.Qu K MY�t�Rr- eM1P.r.0 .�y f:J! ^•1 i P.R tr.y1 P.iRCFL 3ti-"— 'i w. �_ rsrl.a k% «r -NA -i4 tKN � KN�a wwa.r4 `S�N �4C 3o trr s,-tr+e4� •4E�..\._....9fE%L__.. ldalN" \ y`.� rt4�tM Oc:�/V/VI Fp DEPARTMENT USE ONLY J-f/v `I Application Accepted By / Date �'' Area C1 G Employee ID# --E yz 'IQ ?0?� Final Inspection By �Yrnt �(J �!2<✓rs c Date O SPECIAL PERMIT -Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS -rvp PE SC Received ec Amount Date Permit/ Invoice # Permit ID# Code INFO By sh Remitted ServiceR uest# yaaa sa3 lst2 12 1 %I SQ lu 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18