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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-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES' 1 YEAR FROM DATE ISSUE] JOB ADDRESS Q000 / J 1- / d / p (y �75-,? CROSS STREET APIN /CITY/ZIP 2 ll �OJ O �J PARCEL SIZE S ) f I OWNER NAME lh G //—� ✓1 6""IlG/ (-7O 1 -. -� b 2q Sg ft DEPTH PHONE OWNER ADDRESS PC) R ox 90 CITY/STATE/ZIP / �l^, C V � S CONTRACTOR < % r! �G r! -1nae- PHONE 2043 57 26 45521-5- CONTRACTOR ADDRESS 19j, Ni.1 --'/d �G/ CITY/STATE/ZIPef�;/-tS ft LICENSE 1-10C-421-10C-42❑CIC-36 ^ OTHER NUMBER,)25'5k2(57 EXPIRATION DATE�� WATER TABLE DEPTH: LI <,-O ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION �e REPAIR/ADDITION fl ENGINEER DESIGNED /ALTERNATIVE X S REPLACEMENT eVJ SJ?Vr eX',� 5 OUT -OF -SERVICE SEPTIC SYSTEM ❑ DESTRUCTION INSTALLATION WILL SERVE: ❑ RESIDENCE V COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: See' SNS S {eZO 7e T e�[!�� J$ SEPTIC TANK x � TYPE/MFG t/�i'1_T� CAPACITY 4— gal # OF COMPARTMENTS 2 ❑ GREASE TRAP TYPE/MFG IP CAPACITY I gal # OF COMPARTMENTS DISTANCE TO NEAREST: WELL (SVR`( 150 ft FOUNDATION 0490 S� ft PROPERTY LINE 'Of wre ft LIFT STATION SIZE '4% ✓' TYPE OF PUMParsnUj ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) ❑ LEACH LINES ❑ LEACHING CHAMBERS # OF LINES LENGTH OF LINES ft Date Permit/ Service Request # DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft Nr FILTER BED WIDTH (p ft LENGTH (-7O 1 -. -� b 2q Sg ft DEPTH 2 ft SIS 2 DISTANCE TO NEAREST WELL ft FOUNDATION QVC-Y"lU ft PROPERTY LINE S Of V'w e 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 WELL ft FOUNDATION ft PROPERTY LINE ft ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft T 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 HOUR.ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (2091953-7697 SIGNED /i� z TITLE/ ori/,,. ' "i DATE %.2 e<-21 / DEPARTMENT USE ONLY Application Accepted TB�y, 1�4� Date 1Z O Area I �"I Employee ID# rttte► _ Final Inspection By l meq° yA! Date �1-!N `�2.� ❑ SPECIAL PERMIT - Approved by Character of Soil to Depth of 3 Ft: Sir tJP, . Pit/Sump Soil Character: COMMENTS &CP 5<N L5 SRQ0Rq;?Q (sf rJe ells 0'0 sS, rl" ET l7 t o t SSN i�S.All kj bE' p% SS L S P - Sid i I Gerdy bid r ssNzs. iS r�►r�� t�Fc�lr�,/r rocl vnf l� 19�r:c, s��i-�r,�l►�of T PE Code Sc INFO Received B CheSW ash Amount Remitted Date Permit/ Service Request # Invoice # Permit ID# 3 I s3 i 96 13(-0 12-U-41 SIS 2 (�rc�- C o P;G� S� �'s-�- ��►*��E. 0. 0 L Auk - 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18