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/ M 4 BI'-17oS/iI ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 INUN-MLrUNUAULE reRMIT Ca9LL LUbF404-10Y1 FOR INSPECTIONS EXPIRES 9 YEAR FROM UATE ISSUEI JOB ADDRESS 'f6`f oZ M oA r e Dr CITY/ZIPNII�t��# -' Ad 9 T;2 /,,? / CROSS STREET GA - v- A v C APN 6 Q V PARCEL SIZEd _ OWNERNAME A)oC) at -d �.,�n�Sa, i✓I/1ar}I+�tL PHONE .204-605'-'7S29 OWNER ADDRESS Sir vh t CITYISTATE/ZIP �w CONTRACTOR Del .W14A- �CsY. �/ w C PHONE CONTRACTOR ADDRESS CITY/STATE/ZIP LICENSE ❑17C-42 ❑CIC -36 OTHER NUMBER. EXPIRATION DATE WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION ❑ PERC TEST d/ BUILDING PERMIT # TYPE OF WORK: -40? NEW INSTALLATION R PAIR/ADI Coordinates X Y LAND USE APPLICATION # REPLACEMENT ❑ OUT -OF -SERVICE SEPTIC SYSTEM I..l DESTRUCTION GNED/ALTERNATIVE INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMP OYEES: ❑ SEPTIC TANK TYPE/MFG CAPACITY gal # OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS DISTANCE TO NEAREST: WELL /00 It ft FOUNDATION /Zg Y1,+ ft PROPERTY LINE _ 3� ft LIFT STATION SIZE L j .1 TYPE OF PUMP k 442,_ ❑ PKG TX PLANT L3 SAND OIL SEPARATOR (ENCLOSED SYSTEM) ❑ LEACH LINES CI LEACHING CHAMBERS # OF LINES __ LENGTWSft ft FOUNDATION ft TY LI �. ft ft DEPT ft ft FOUNDATION ft PROPERTY PROPERTY LI ft ft DEPTH ft ft FOUNDATION ft PROPERTY LINE ft ft DEPTH ft ft FOUNDATION ft PROPERTY LINE ft ft DEPTH ft ft FOUNDATION ft PROPERTY LINE ft ft DEPTH ft 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. SIGNED WV% If V% IV L.I+I IVIY.J - r-LL.I'Ilip L IICU J/ TITLE Ovi nx-,� DATE DEPARTMENT SE ONLY Application Accepted By Date. Area Employee ID# �]�-- Final Inspection By Date ❑ S EC AL PERMIT -Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS /4?Au --kr AA. D11. - ! r4 R L -A-V, _ PE Code DISTANCE TO NEAREST WELL r / elk#/ Amount V " si"i Remitted C FILTER BED WIDTH ft LENGTH DISTANCE TO NEAREST WELL I+ MOUNDED WIDTH ft LENGTH DISTANCE TO NEAREST WELL ❑ SUMPS WIDTH ft LENGTH DISTANCE TO NEAREST WELL ❑ DISPOSAL PONDS WIDTH ft LENGTH DISTANCE TO NEAREST WELL ❑ SEEPAGE PITS NUMBER WIDTH DISTANCE TO NEAREST WELL # OF LINES __ LENGTWSft ft FOUNDATION ft TY LI �. ft ft DEPT ft ft FOUNDATION ft PROPERTY PROPERTY LI ft ft DEPTH ft ft FOUNDATION ft PROPERTY LINE ft ft DEPTH ft ft FOUNDATION ft PROPERTY LINE ft ft DEPTH ft ft FOUNDATION ft PROPERTY LINE ft ft DEPTH ft 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. SIGNED WV% If V% IV L.I+I IVIY.J - r-LL.I'Ilip L IICU J/ TITLE Ovi nx-,� DATE DEPARTMENT SE ONLY Application Accepted By Date. Area Employee ID# �]�-- Final Inspection By Date ❑ S EC AL PERMIT -Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS /4?Au --kr AA. D11. - ! r4 R L -A-V, _ PE Code SC INFO Received r / elk#/ Amount V " si"i Remitted Date Permit/ Service Re uest # ID# P" Triq 16 sll 3 va I+ � SI tmit 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18 C C rn