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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E, HAZELTON AVENUE - STOCKTON CA 95205 - (209) 4683420 I ION-KEFUNDABLE PERMIT A GALL LUN &3J-f0Y1 FORJNSPECTIONS LXPIRES 9 YEAR FROM DATE ISSUEI JOB ADDRESS iT48 S. /41 r—pn z --r v.iA-r CITY`/1ZIIPP 1- 1AW-r�C� �jS-33i6 CROSS STREET A 1 \Z p OIZ � �`il a -r APN ZO4 - VLQ —W+ PARCEL SIZE 1 OWNER NAMES/iI.I�+A �1_j VC%� I I/l�i ��(\) �IS'� C��JL� CI7 PHONE Z09 - 9 &ZZ` OWNER ADDRESSS) I- D0 )LV �T \QA I CITY/STATE/ZIP CONTRACTOR SUJb�PloiZ 0" squ SD11,:0(>O5 PHONE 5�� CONTRACTOR ADDRESS 3(oD`j D1;ncASu�,J �� .31 CITY/STATE/ZIP SrNC¢ IlGla-rL, CA LICENSE 0GC-42 ❑LC -36 OTHER O NUMBER 4EZ9 54 6 EXPIRATION DATE WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: COOrdlnates X Y ❑ PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # L39-01-09_ TYPE OF WORK: V NEW INSTALLATION ❑ REPAIR/ADDITION V1 ENGINEER DESIGNED /ALTERNATIVE G REPLACEMENT r' OUT -OF -SERVICE SEPTIC SYSTEM I''DESTRUCTION INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: 1 NUMBER OF BEDROOMS: 4 NUMBER OF EMPLOYEES: O SEPTIC TANK TYPE/MFG uhr i Y �s f��✓_M � QEII 14 4f�J1'ir.APAr.ITv Z41)D nal * OF: r.nMPARTMFNTR Z ❑ GREASE TRAP TYPE/MFG //�� DISTANCE TO NEAREST: WELL I V b t' ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ CAPACITY gal # OF COMPARTMENTS FOUNDATION O ft PROPERTY LINE 56 ft PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) fz I I�;p L -C -MM LINES L'. LEACHING CHAMBERS Check#/ Amount Permit/ Cash Remitted - D to Service Re nest # # OF LINES 6 LENGTH OF LINES ` OO _ ft TO NEAREST `` //�� O+ WELL 1 O + ft Ib FOUNDATION 4- ft PROPERTY LINE SD ft ❑ FILTER BED WIDTH ft LENGTH 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 LIN ft ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPEIt,7Qft JT'� ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH E� Q(I/ ft DISTANCE TO NEAREST WELL ft FOUNDATION ,� ft PROPER 11V07 I7€�TdT*ry ft I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDIN%&€S, STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. kEARTMENT X SE ONLY �J Application Accepted B Date Area l Employee ID# Final Inspection By Date 0 l �-p uj ❑ SPECIAL PERMIT - Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS (5FA--(.00" 5�.R, V;4 PE SC Code INFO Received B Check#/ Amount Permit/ Cash Remitted - D to Service Re nest # Invoice # Permit ID# o '" 42-01 2ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18 71 -29 rn tv d ►IJ 3