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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-KEFUNDABLE PERMIT �y GALL ZU9 90J-/C'J/ FOR (-1 t JOB ADDRESS 1-1195 Q,e I TEAK FK(JM LJAIL 155ULU CROSS STREET T� Y�l� 1 \�(� AP V PARCEL SIZE ©fes OWNER NAME Y i S l,� S -11 C'T C_T LV c,-4 PHON 1� Q� / -3Z3 OWNER ADDRESS �!J ,(1),Y\A S � L � 4 CITY/STA IP S -t --c '1 �I (A Som CONTRACTOR LI r ^� PHONE1� �G �C\5 CONTRACTOR ADDRESS / I ., 1 V 1 j2 CITY/STATE/ZIP LICENSE I _C-42 U[IC-36 NUMBER EXPIRATION DA WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT # LAND USE APPLICATION #_ TYPE OF WORK' NEW INSTALLATION REPAIRIADDITION ENGINEER DESK 1 REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION �- ft FOUNDATION INSTALLATION WILL SERVE: I I RESIDENCE tJ COMMERCIAL 41 OTHER ft LENGTH ft DEPTH ft DISTANCE TO NEAREST NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEE . ❑ ❑ SEPTIC TANK TYPE/MFG CAPACITY gal # OF COMPARTMENTS ft DEPTH It ❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS ft FOUNDATION DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft ❑ 4ATC4 SIZE TYPE OF PUMP 11PKG TX PLANT 13 SAND OIL SEPARATOR (ENC SED SYSTEM) LEACHING CHAMBERS # OF LINES LENGTH OF LINES AV DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LIN ED WIDTH ft LENGTH ft DEPTH DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE 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 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL !2091953-7697 SIGNED TITLE DATE PT�c YMENT CEIVED Y 0 3 2019 QUIN COUNTY IONMENTAL DEPARTMENT DkQ4A M E N T U S E N L Y Application Accepted ByDate Area Employee ID#jj�" Final Inspection By Date 11 SPECT L PERMIT -Approved I Character of Soil to Depth of 3 Ft: ` rN Pit/Sump Soil Character: COM ENTS V -1,0 V ° Y� ! J PE I SC Received #/ Amount Date Pertnit/ Invo i Code INFO By 1/JBfsOti Remitted _Service Request# ■ ■ , T7 Ii• 42-01 ONSITE 4/14/18 DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE it ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH It 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 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 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL !2091953-7697 SIGNED TITLE DATE PT�c YMENT CEIVED Y 0 3 2019 QUIN COUNTY IONMENTAL DEPARTMENT DkQ4A M E N T U S E N L Y Application Accepted ByDate Area Employee ID#jj�" Final Inspection By Date 11 SPECT L PERMIT -Approved I Character of Soil to Depth of 3 Ft: ` rN Pit/Sump Soil Character: COM ENTS V -1,0 V ° Y� ! J PE I SC Received #/ Amount Date Pertnit/ Invo i Code INFO By 1/JBfsOti Remitted _Service Request# ■ ■ , T7 Ii• 42-01 ONSITE 4/14/18