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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-REFUNDAB:E PERMIT CALL (209) 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS -680 UQ I I Q L A) CITYIZIP IL-4) d11S CROSS STREET Or, fnrey APN O3 o,3 I 1 PARCEL SIZE I A OWNER NAME to Id L VQA S PHONE -23469— V DINNER ADDiESS 1iGmC CITY.'STATEIZIP CONTRACTOR Sep:,c Services Group CONTRACTOR ADDRESS PO BOX 569 LICENSE C42 C-36 OTHER A NUMBER 11!66tG6 PHONE 916-2133-6259 CITY/STATE/ZIP Wilton. CA -95693 EXPIRATION DATE 8-31-2022 WATER T..S: - DEPT-, fl GEOGRAPHICAL INFORMATION: Coordinates X Y PERC TEST BUILDING PERMIT # It FOUNDATION LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION REPAIR/AODITION ENGINEER DESIGNED /ALTERNATIVE ft FOUNDATION REPLACEMENT OUT -0F -SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: RESIDENCE COMMERCIAL OTHER NUMBER OF LIVING UNrrS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: 2 SEPTIC TANK TYPEIMFG _ _ CAPACITY gel # OF COMPARTMENTS ❑ GREASETRAP TYPE/MFG CAPACITY gal #OFCOMPARTMENTS DEPTH ft DISTANCE TO NEARES'.-: WELL ft FOUNDATION ft PROPERTY LINE ft ❑ UFT STATION SIZE TYPE OF PUMP 0 PKG TX PLANT 13 SAND OIL SEPARATOR (ENCLOSED SYSTEM) LEACH LINES LEACHING CHAMBERS # OF LINES _L LENGTH OF LINES 497– ft DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft ❑ FILTER BED WIDTH ft LENGTH R DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE h Q MO'j!:,) = WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL It FOUNDATION It PROPERTY LINE It ❑ SUMPS WIDTH ft LENGTH ft DEPTH It DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE it ❑ DISPOSAL PONDS WIDTH It LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft SEEPAGE PITS iNLMBER I WIDTH .3 ft DEPTH Z S it DISTANCE TO NEAREST WELL_1_70 '. FOUNDATION 16 it PROPER 7YLJNE ft I HEREBY CERTIFY THAT i HAVE PREPARED THIS APPUCATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES. STATE '_AWS AND RULES AND REC:!LATIONS OF SAN JOAQUIN COUNTY. MINIMUM 48 HANCc OTICE RE UIREL` FOR INSPECTIONS - CAL(2091953-7697 r 1'7 — L —ZOZ-� SIGNED TITLE DATE _ 0EPARTMEVT JJ S E ONLY [� r Application Accepted By _ �_A Dated1 2 t — Area l �7 Employee ID# �i 131 l l V Final Inspection By A Data i 1 '.,.! .L_LSPECIAL PERMIT -Approved by Character of Soil to Depth of Ft: 't—=—q'PtUSum-Ij S ---oil Character: COMMENTS SoimCl 2,jrlIPS� OYl Parcel is i2Rg or -jus be ++ sect 5v O.'r. eT• EA"bh4 <Vs -6w Assowei-) :f!;, lov C—b& in i Ia9ib PE SC Recelv*dCIlieciallif Amount Permit/ Invoice # Permit ID# Code Iwo h emitted Service R _ yaiLl 5, S 3yn' «� — 42.01 ONSITE 4JA5 •:-en "RTLINT SYSTc'I PEFPdIi 4/14118