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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 EXPIR �y.S.LES 1�� YEAR FROM DATE ISSUED JOB ADDRESS /4'��,y�t�J� r�/ —7 'CIITY/ZIP �IQA/ 7 J CROSS STREET L C1 L f li�� f�-� APN� / 7-e,' _b l -PARCEL //SIZE ., OWNER NAME Sc{.�14 c�t{tAti tl F�LG PHONE Alp (�j�✓'�� OWNERADDRESS��Z 2�C/L/t/ /%��. CITY/STATE/ZIP CONTRACTOR f77TU�L/ l /� C PHONE CONTRACTOR ADDRESS CITY/STATEIZIP �0:4' L li!! L�^� G�+� ejr' 7� LICENSE ❑ -1C-42 ❑LiC-36 OTHER NUMBER EXPIRATION DATE WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordi'm ❑ PERC TEST # F UILDING PERMIT # TYPE OF WORK: ❑ NEW INSTALLATION I I REPAIR/ADDITION FI REPLACEMENT J OUT -OF -SERVICE SEPTIC Y CATION # NGINEER DESIGNED /ALTERNATIVE INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL I_I OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPE/MFG CAPACITY heck# Amount Date gal # OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY INFO gal # OF COMPARTMENTS Cash Remitted Service Request # DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) ❑ LEACH LINES I .' 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 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 ❑ DISPOSA(. ft LENGTH ft DEPTH ft YY��II EIVMOYEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ SEEPAC. E,E'Jj��gy� WIDTH ft DEPTH ft EE1�[�1L�`p� 9 EST 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. IV11lVIlV VI 40 r% H H LJI A—C rXC IJIrCCLJ !—'Vr'C NVJI'C 1.11VIYJ I—LCHJC IiHLL LV: SIGNE TITLEDATE Application Accepted By Final Inspection By Character of Soil to Depth of 3 Ft: to COMMENTS 1!C --k-6 A r I Area ❑ SPE Pit/Sump Soil Character: / Employee I D# &MW._ , IAL ER - Approved b pp Y PE SC Received heck# Amount Date Permit/ I mit ID# Code INFO By Cash Remitted Service Request # 317 Z 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18 rye n 0 n