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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPA T E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 NON-REFUNDABLE PERMIT / I CALL 209 953-7697 FOR INSPECTIO N Alk EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS (S IL 7 ! 7 CITYIZIP `Tt a ESA CROSS STREET 1J� "� 1`� APN Z� 0 (/ / / PARCEL SIZE_ OWNER NAME ��A�G� r�11/�J �I. 1 '{ PHONE" � 7()4, C ��a5 � OWNER ADDRESS `P ` ppyo"' '� J ✓ CITY/STATE/ZI%P� / /-A,77 ( ^� `C CONTRACTOR O V� V`�r `rt �� V� PHONE `-� �Y l r V �V 7 / CONTRACTOR ADDRESS -2) A 1 CITY/STATE/ZIP LICENSE 11 C-42 1111C-36 OTHER NUMBER EXPIRATION DA WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION 1_I ENGINEER DESIGNED /,ALTERNATIVE REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION S G INSTALLATION WILL SERVE: C RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPE/MFG CAPACITY gal # OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS DISTANCE TO NEAREST: WELL ❑ LIFT STATION SIZE TYPE OF PUMP ❑ LEACH LINES LEACHING CHAMBERS D ANCE TO NEAREST WELL ❑ FI H ft LENGTH i ISTANCE TO NEAREST WELL WIDTH ft LENGTH DISTANCE TO NEAREST WELL WIDTH ft LENGTH DISTANCE TO NEAREST WELL DISPOSAL PONDS WIDTH ft LENGTH DISTANCE TO NEAREST WELL SEEPAGE PITS NUMBER WIDTH _ DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) # OF LINES LENGTH OF LINES ft FOUNDATION ft PRO N 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 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 VPC llvar-C1. 11V/YJ - P-L-CNJC IdYLL I AV: TITLE "'016 ' DATE Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS I/IA��SI�oP ?7cic5L_ l-iduJC %?i/lLmltii 7� fZ— AyZ97 PE SC Received Check#/ Amount Code INFO By Cash Remitted r PermiU Invoice # Service Request # _ PermitID# 42-01 ONSITE WASTEWATER TRTMN=91'EM PERMIT 4/14/18 m v 0 m v.