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1 ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE -STOCKTON CA 95205 -(209) 468-3420 NON-KEFUNDABLE PERMIT ;/ALL ZUY 9b3-/tiy/ FOR INSPECTIONS LXPIRES 9 YEAR FROM DATE ISSUE JOB ADDRESS -D%0 512a7 -L( "R -z -AA 12,9A I) CIT/YYIZIP 5261 4q e'A fi%P 9.63.20 CROSS STREET /LZE GAlyho APN /9 3 —O7 D -a f PARCEL SIZE OWNER NAME PEACE PHONE OWNERADDRESS -7970 SDuTN 11 A2LAt, 20A1`2 CITY/STATE/ZIP FRENCH (AmP CA 9U ze) CONTRACTOR PHONE 4,9, — /6112 CONTRACTOR ADDRESS /F.0 , /SOX 3%-IG4 CITY/STATE/ZIP �, (ZL.U[(C, cA q5-3,91 LICENSE ❑DC -42 ❑OC -36 OTHER NUMBER EXPIRATION DATE /3D /a WATER TABLE DEPTH: v Z ft GEOGRAPHICAL INFORMATION: Coordinates X Y PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # TYPE OF WORK: E. NEW INSTALLATION CI. REPAIR/ADDITION [I ENGINEER DESIGNED /ALTERNATIVE ❑ REPLACEMENT ❑ OUT -OF -SERVICE SEPTIC SYSTEM C'. DESTRUCTION 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 LEACH LINES ❑ LEACHING CHAMBERS_ FOUNDATION DISTANCE TO NEAREST WELL FILTER BED WIDTH ft FOUNDATION DISTANCE TO NEAREST WELL MOUNDED WIDTH ft FOUNDATION DISTANCE TO NEAREST WELL SUMPS WIDTH ft FOUNDATION DISTANCE TO NEAREST WELL DISPOSAL PONDS WIDTH ft FOUNDATION DISTANCE TO NEAREST WELL SEEPAGE PITS NUMBER ft FOUNDATION DISTANCE TO NEAREST WELL gal # OF COMPARTMENTS gal # OF COMPARTMENTS ft PROPERTY LINE ft ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) # OF LINES LENGTH OF LINES ft ft PROPERTY LINE ft ft DEPTH ft ft PROPERTY LINE ft DEPTH ft PROPERTY LINE�1��1{{** ft DEPTH e. • _ 2g4. ft PROPERTY LINErteJDA ft DEPTH ON t ft PROPERTY LINE p'�Ti►w,.- fTTt ft DEPTH Tt 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, /1 STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. IV/II IVI UIVI 'fo /7 HUVH/VL C IVU I m'c /[C UII[CLl r-Urx IIV.7rCli I IV/VJ - r-LCHJC L.HLL LU: SIGNED TITLE i X7011 L EfV! ,11JE2 95DATE DEPARTMENTiVS& ONLY Application Acceptedy �� . G� Date o� dd Area 3 Employee ID# _ Final Inspection By Date �Z (3D 2oZ\ EJ SPECIAL PERMIT -Approved by Character of Soil to Depth of 3 Pit/Sump Soil Character: COMMENTS EO tdHr�_fr, Off- P'rc94-_� PE Code ft FOUNDATION LENGTH Amount Remitted Date Permit/ Service Request # ft FOUNDATION LENGTH 5 3 ft FOUNDATION LENGTH ft FOUNDATION LENGTH ft FOUNDATION WIDTH ft FOUNDATION ft ft PROPERTY LINE ft ft DEPTH ft ft PROPERTY LINE ft DEPTH ft PROPERTY LINE�1��1{{** ft DEPTH e. • _ 2g4. ft PROPERTY LINErteJDA ft DEPTH ON t ft PROPERTY LINE p'�Ti►w,.- fTTt ft DEPTH Tt 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, /1 STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. IV/II IVI UIVI 'fo /7 HUVH/VL C IVU I m'c /[C UII[CLl r-Urx IIV.7rCli I IV/VJ - r-LCHJC L.HLL LU: SIGNED TITLE i X7011 L EfV! ,11JE2 95DATE DEPARTMENTiVS& ONLY Application Acceptedy �� . G� Date o� dd Area 3 Employee ID# _ Final Inspection By Date �Z (3D 2oZ\ EJ SPECIAL PERMIT -Approved by Character of Soil to Depth of 3 Pit/Sump Soil Character: COMMENTS EO tdHr�_fr, Off- P'rc94-_� PE Code SC INFO ReceivedCheck# By TM Amount Remitted Date Permit/ Service Request # Invoice # Permit ID# yaaa 5 3 $ISa 2 z2 21 0� 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18 T