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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-REFUNDABLF PERjMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS � l S _, ? 7NJ 2 �-"�L CITY/ZIP // �.i'J/�J//� CROSS STREET LV// J�i2 /C.*/X� - I _ APN `� J� Oj PARCEL SIZE �' b OWNER NAME f2) C �I c: r L4 /I'JJV �i r{{6��) D r C PHONE �f OWNERADDRESS �,'i )'N['––I� r;j-, C.IF<' ��✓L'F CITY/STATE/ZIP/!J't, L le 10 r `r��`1 CONTRACTOR PHONE I%f.'(/ �C///�� PHONE 7C✓ 7 S U/�Z'7/ CONTRACTOR ADDRESS i / Y (u /�� fCG'l /////G ``�'�� CITY/STATE/ZIP ��/ 4J U�'y LICENSE ;KC -42 C-36 OTHER -__ NUMBER V 'EXPIRATION DATE WATER TABLE DEPTH: .i ft GEOGRAPHICAL INFORMATION: Coordinates X PERC TEST # F BUILDING PERMIT # OOCZS LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION\t� REPAWADDITION ENGINEER DESIGNED /ALTERNATIVE REPLACEMENT (� OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE:RESIDENCE 1.1 COMMERCIAL �@@ U OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: X2 NUMBER OF EMPLOYEES:.___ SEPTIC TANK TYPE/MFG CAPACITY 116eti gal # OF COMPARTMENTS__ ❑ GREASE TRAP TYPE/MFG CAPACITY Jai # OF COMPARTMENT�-y� S DISTANCE TO NEAREST: WELL /�.v It FOUNDATION �Z, ft J PROPERTY LINE " �r ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) W�LEACH LINES LEACHING CHAMBERS ` # OF LINES LENGTH OF LINES 55 , ft DISTANCE TO NEAREST WELL ?-Lk) / _ fl FOUNDATION 7_ 5 it PROPERTY LINE S� ft ❑ FILTER BED WIDTH ft LENGTH ft DEPTH It DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE ft ❑ MOUNDED WIDTH ft LENGTH ft DEPTH fl DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It ❑ SUMPS WIDTH It LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ DISPOSAL PONDS WIDTH It LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LL'IINE fl 0 ---SEEPAGE PITS NUMBER JL– WIDTH ft DEPTH 6� 7 ft DISTANCE TO NEAREST WELI'?'I'1 _ It FOUNDATION jjJ- ft PROPERTY LINE_ft I HEREBY CERTIFY THAT 1 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. N C C F Application Accepted By �— Final Inspection By Character of Soil to Depth of 3 Ft: COMMENTS /�<-,vJ J Fk Date Area Ll Employee ID# t� t. A2- 7 Date r /y�LZ ❑ SPECIAL PERMIT -Approved by _ Pft/Sump Sol[ Character: Ilpr r'��. S o��Sa l PC; c< �It S3 ti, vl f'nGVI Uf 2q. r�d � e� l- rJ 'htr ra00 C�Pt Or pi; SSJhIf, VP;'L'. PE SC Received heck#/ Amount Permit/ Code INFO B Remitted Die Service Re ueat M Invoice # Permit ID# y I I i 1 $S -X-1, �U L1 42-01 4/14118 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT