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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 SC INFO CALL (209) 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS.y./�S �i^/�%GL�/'G 1-00J CITY/ZIP CROSS STREET D �1 i .' M APN / j" �Cl PARCEL SIZE OWNER NAME �_�'/��jL/% /`! �`LL/� 3RTT PHONE OWNER ADDRESS CITY/STATE/ZIP �C`�/�,GL/J� CONTRACTOR / Q/{ PHONE � (�/ J �� Zzz7 CONTRACTOR ADDRESS CITY/STATE/ZIP r_ LICENSE 11I.IC-42 ❑❑C-36 OTHER NUMBER _ EXPIRATION DATE FEJT WATER TABLE DEPTH: ., ft GEOGRAPHICAL INFORMATION: Coordinates X ■-`J TREU ❑ PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # TYPE OF WORK: CI NEW INSTALLATION ❑ REPAIR/ADDITION LI ENGINEER DESIGNED /ALTERNATIVE CI REPLACEMENT Ne OUT -OF -SERVICE SEPTIC SYSTEM S DESTRUCTION INSTALLATION WILL SERVE: 1.1 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 ft FOUNDATION ft PROPERTY LINE ft ❑ LIFT STATION *''T`ZE TYPE OF PUMP ❑ PKG TX PLANT ® SAND OIL SEPARATOR (ENCLOSED SYSTEM) ❑ LE: L HING CHAMBERS # OF LINES LENGTH OF LINES ft TANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft L3FIL WIDTH ft LENGTH ft DEPTH DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ❑ M NDED WIDTH ft LENGTH ft DEPTH , _ DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINg%�9n ft El SUMPS WIDTH ft LENGTH ft DEPTH — ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LI LONM&A�V-7UNnft ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH gRTM&A,j. _ 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 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. MIND 48 H R ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL 209 953-7697 SIGNED TITLEl'JGt/.N/"�/[ DATE / t-Inal Inspection tsy Date LJ JP IAL PERMIT - Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil C(r�ct COMMENTS �, - gJ� 0 oQ[.tn� L J '&V rzo U 3 _�Pefr►�� grl tbuts tic; s./31vw19 it _ c � e'-'61 bf _ Pen. l bef VC _beer_! _�&'s 3i V AIPy a� aI PE Code SC INFO Received B Che es Amount Remitted D to Permit/ Service RegU t # it ID# Z .' 13 S'+L 3 / 3RTT 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18 vp b d In