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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE-STOCKTON CA95205 - (209) 468-3420 NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED tL JOB ADDRESS r J :� l r s ✓I L-.<- Ke C' ID,LYrv/ZIP CROSS STREET W 60d jJ %Z I (��k4TC" ! I C-C�t' APN Wy t� `Z U J OWNERNAME�I�r��/t(,,Xp� I CV` 4- P OWNER ADDRESS Sc: M ` CITYISTATE/ZIP CONTRACTOR Septic Services Group PHONE 916-203-6259 PARCEL SIZE 2,33 CONTRACTOR ADDRESS PO BOX 569 CITY/STATEIZIP Wilton, CA -95693 LICENSE _I C-42 I C-36 OTHER'A' NUMBER 1068208 EXPIRATION DATE B-31-2022 WATER TABLE DEPTH: 1 0 v ft GEOGRAPHICAL INFORMATION: Coordimtes X Y PERC TEST # BUILDING PERMIT # • d' 0t �y N LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION R AIR/ADDITION ENGINEER DESIGNED /ALTERNATIVE REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: COMMERCIAL OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: £ SEPTIC TANK TYPE/MFG j S CAPACITY 1 C�t�J 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) a YMFNT V 01 2021 ,1V Cp DEPARTMENT USE ONLY L� ft*F A j At Application Accepted B—/�� AU Date Area 1 �� Employee ID#� MfNT Final Inspection By { (��L.t c CV SIC AU L• Date SPECIAL PERMIT - Approved by Character of Soil toDepthof 3 Ft: Pit/Sump Soil Character: v COMMENTS 1Phl CK ki✓ !')Off n�', inl }h �I7 r L7O h'� . 1;f, r PE SC Received Check#/ Amount Date Permit/Invoice # Permit ID# Code INFO B Cash Remitted Service Request # ��3 07 sgq 11h Im 414�t8 � (� ^ �, r� ONSITE WASTEWATER TRTMNT SYSTEM PERMIT LEACH LINES LEACHING CHAMBERS # OF LINES I LENGTH OF LINES t'I Z ft DISTANCE TO NEAREST WELL / `' L' ft FOUNDATION O ft PROPERTY LINE o�..�'r It ❑ 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 it LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL LLINE ft FOUNDATION ft PROPERTY LINEft SEEPAGE PITS NUMBER `J WIDTH / _ft DEPTH c It DISTANCE TO NEAREST WELL �S� -7 ft FOUNDATION _ �% �ft PROPERTY LINE [, CJ 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 HADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL 209 953-769 SIGNED TITLE IC- 44 0 DATE 9 — 749-. ZOZ a YMFNT V 01 2021 ,1V Cp DEPARTMENT USE ONLY L� ft*F A j At Application Accepted B—/�� AU Date Area 1 �� Employee ID#� MfNT Final Inspection By { (��L.t c CV SIC AU L• Date SPECIAL PERMIT - Approved by Character of Soil toDepthof 3 Ft: Pit/Sump Soil Character: v COMMENTS 1Phl CK ki✓ !')Off n�', inl }h �I7 r L7O h'� . 1;f, r PE SC Received Check#/ Amount Date Permit/Invoice # Permit ID# Code INFO B Cash Remitted Service Request # ��3 07 sgq 11h Im 414�t8 � (� ^ �, r� ONSITE WASTEWATER TRTMNT SYSTEM PERMIT