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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 -( ALL JOB ADDRESS X-42-4 00, Fe -4 EFp- LN EXPIRES 1 YEAR FROM DATE ISSUE. =-D^1 41521S CROSS STREET W^Tf-rz L- ,p �,y. (� APN 10,- 02-2-�� PARCEL SIZE �'rri-7 Ac OWNERNAME FE►�NP1NDv CE1ey&^JTES PHONE 19(9Z- 7-'1'4'1''T I OWNER ADDRESS CIO ONAV-60 CP�AC M C Op , 11 5'TO ND 1`�"tJ CRY/STATE/ZIP L C r -7D N CA CONTRACTOR L1 L/6 0^'V- GEbEN VI"r/ft1 E -N I A -L- PHONE 31pri -03'7 S CONTRACTOR ADDRESS 40-7 W • V^15-' ST' CITY/STATE/ZIP ISD I C49 9SZTO LICENSE . 'C-42 Ll C-36 OTHER CELT NUMBER 2-1 I EXPIRATION DATE 4-30-2--L WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE ft FOUNDATION REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE:_': RESIDENCE L 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 ❑ MOUNDED DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) ❑ LEACH LINES LEACHING CHAMBERS ec / # OF LINES Code LENGTH OF LINES ft sh DISTANCE TO NEAREST WELL S"a3 ft FOUNDATION )sa 44w S9CMqVT ft PROPERTY LINE It ❑ FILTER BED WIDTH It LENGTH It DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It ❑ MOUNDED WIDTH ft LENGTH It 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 It DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft 1 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. Final Inspection By i Date ❑ SPECIAL PERMIT - Approved by Character of Soil to Depth of - Pit/Sump"Soil Character: _ L COMMENTSG III Afi � tF<< I/t� SGZk•G� Ii`!�r •� PE SC SC Received ec / Amount Dat Permit/ Invoice # Permit ID# Code INFO B sh Remitted Service Request # S"a3 ( )sa 44w S9CMqVT 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18