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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 rvvN-RtrurvUAtiLt rEKMIT UALL ZU9 953-7697 FOR INSPECTIONS EXP I RES 1 YEAR FROM DATE ISSUE JOB ADDRESS i4 I CITY/ZIP ,y ' CROSS STREET ,p�[�,% /�'�&jd APN 0 27o-70 11 PARCEL SIZE OWNER NAME to r rr 3 Sp I Y .6i N D PHONE OWNER ADDRESS Q �1 SJ S C h e o k e e CITY/STATE/ZIP CONTRACTOR /��(�}{ Pal—\1r�' PHONE CONTRACTOR ADDRESS ` CITY/STATE/ZIP LICENSE ❑❑C-42 ❑❑C-36 OTHER NUMBER J EXPIRATIONDATE WATER TABLE DEPTH: (O o – / O ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT # )6106,d3CI LAND USE APPLICATION # TYPE OF WORK: ❑ NEW INSTALLATION 0 REPAIR/ADDITION ❑ ENGINEER DESIGNED /yA.,LTERNATIV ❑ REPLACEMENT ❑ OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION P ' 1 }G' V1 INSTALLATION WILL SERVE: I RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: /,Ii♦1 SEPTIC TANK TYPE/MFG 1 CAPACITY gal # OF COMPARTMENTS_ � v � T ❑ GREASE TRAP TYPE/MFG CAPACITY a bOFgal # OF COMPARTMENTS% DISTANCE TO NEAREST: WELL Z, ft FOUNDATION F ft PROPERTY LINE 6` "' ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) s 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. TITLE e7, f!/l DATE / NTY DEPARTMENT US 8 ONLY j Application Accepted B Date , ri0 Area `I I Employee ID# r41 Yi K C, r Final Inspection By Date ❑ SPECIAL PERMIT -Approved by Character of Soil to Dept of 3 Ft: t/Sump Soil Character: COMMENTS I-�o F_. T9, I�tewI�C'rl Sc7 Gat loC-r wits Demo O PE LEACH LINES ❑ LEACHING CHAMBERS Amount Permit/ # OF LINES -3 LENGTH OF LINES ) ft 4 INFO B Cash DISTANCE TO NEAREST WELL ft FOUNDATION �� ft PROPERTY LINE _ ft ❑ FILTER BED WIDTH ft LENGTH �/b _ ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft SEEPAGE PITS NUMBER S WIDTH ft DEPTH j ft DISTANCE TO NEAREST WELL %h /-I ft J FOUNDATION %d 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. TITLE e7, f!/l DATE / NTY DEPARTMENT US 8 ONLY j Application Accepted B Date , ri0 Area `I I Employee ID# r41 Yi K C, r Final Inspection By Date ❑ SPECIAL PERMIT -Approved by Character of Soil to Dept of 3 Ft: t/Sump Soil Character: COMMENTS I-�o F_. T9, I�tewI�C'rl Sc7 Gat loC-r wits Demo O PE SC Received Check#/ Amount Permit/ Code INFO B Cash Dat Invoice # Remitted Service Request # Permit ID# -1311 0-7 -7 Z© s-,?tj :t7 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18