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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-KEFUNDABLE h'ERMII JOB ADDRESS -3,_ . LL LUY Y0J-10Y1 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUE A I CITY/ZIP y sL Cr / U CROSS STREET V� API t "C/ PARCEL SIZE 2 OWNER NAME / ( %/�% q�P f/�L�jy(R ),l1/�Cf� PHONE OWNER ADDRESS �� L� �R 4 CITY/STATE/ZIP //�<< y. Zc',,, ' CONTRACTOR Q e SS PHONE (� r bj� / CONTRACTOR ADpL / CITY/STATE/ZIP //,r-2 LICENSE IC -42 [].,—,C -36[].,—,C-36 OTHER NUMBER : 7 6/ EXPIRATION DATE WATER TABLE DEPTH: ✓�- -I ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT # 6P- 91009 06 LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION I I ENGINEER DESIGNED /ALTERNATIVE REPLACEMENT I OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL 1 / 11OTHER NUMBER OF LIVING UNITS: 7 NUMBER OF BEDROOMS: A<�� }loonJ NUMBER OF EMPLOYEES: n CGPTw TANV TVDr/KArn (.APA(`ITV 2 !/L/ D nqI }I OP rhtAPARTMFNTC ❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS/ / DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE /O�>t- ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) LEACH LINES LEACHING CHAMBERS # OF LINES LENGTH OF LINES �C`/® ft DISTANCE TO NEAREST f WELL ZG9(� D •T ft FOUNDATION.�� ft PROPERTY LINE JLC 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 LINE ft ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH 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. MINIMUM 4&11014R ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL 209 953-7697 ` TITLE Z/ /;A SIGNED n e 6wDATE S c� C ^r T T �j Application Accepted By /�� L L DEPARTMENT USE ONLY Date r i�I a Area Employee ID#_ Final Inspection By �Yc<✓tr_S(v,�.,�� Date 1 1 2,817 2 ❑ SPECIAL PERMIT -Approved by Character of Soil to Depth of 3 Ft: PitiSump Soil Character: COMMENTS lt1 1 Ion bf 1�>»S ©ri�in�� st t( F1mli J,. is for brrl s. C I �e shows -7 bFdvookwSullh �eu.l , e1r^�i i no ins crD� le�A,}ecj or ex r,-+ le-,(4)oi oh " )reCj :g %at 1,11es ��</ �,�} fAg&�Li ,o,^ we( PE� Code SC INFO Received B ,,—ChjcW sh Amount Remitted Dat Permit/ Service Request # Invoice # Permit ID# l i 1 S� 3Jb 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18