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a ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 I14UN-MtI-L1NUAtSLt rtKMI I GALL (ZUY) U0.5-IbUt FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUE JOB ADDRESSYob /�%li Z ,; .k;k)e_ LU /CITYIZIP'._) CROSS STREET APN OD �y DO PARCEL SIZE OWNER NAME 61"'el S Lllc""� PHONE OWNER ADDRESS q?T S/. Glf rokee L,;1 CITY/STATE/ZIP �.00�f, ��ago CONTRACTOR G %J / ' PHONE CONTRACTOR ADDRESS W / C CITY/STATE/ZIP LICENSE ❑)(C-42 ❑❑C-36 OTHER NUMBER EXPIRATION DATE O VII -09 WATER TABLE DEPTH: -70 _ b O ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT # t9JOS-06 LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION FI REPAIR/ADDITION CI ENGINEER DESIGNED /ALTERNATIVE Li REPLACEMENT 0 OUT -OF -SERVICE SEPTIC SYSTEM ❑ DESTRUCTION INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL OTHER In - f �VG1 NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: SEPTIC TANK TYPE/MFG CAPACITY �Cb gal # OF COMPARTMENTS_ ❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS 3-6, DISTANCE TO NEAREST: WELL ft FOUNDATION few) ft PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) 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. IV1IlVll IVl #a PIVUIC HUVA41VI.0 1Vv11L'C PCC v1IxCU rvR SIGNED TE % Z_ DEPARTMENT USE ONLY Application Accepted By � L _ Date IZIOZA?l Area `I o Employee ID# Final Inspection By lri t., �; S [U � 6- �u Z Date J�Z-7/Z V 1Z ❑ SPECIAL PERMIT -Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS & RO A Ni F r_ PE Code LEACH LINES ❑ LEACHING CHAMBERS # OF LINES _ 3 LENGTH OF LINES k!5-' ft Date Permit/ Service Request # DISTANCE TO NEAREST WELL ISO' ft FOUNDATION 3-6, ft PROPERTY LINE Sty 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 3 WIDTH 6K, ft DEPTH '�g�r ft DISTANCE TO NEAREST WELL ft FOUNDATION _ '5110 ft PROPERTY LINE 5[7 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. IV1IlVll IVl #a PIVUIC HUVA41VI.0 1Vv11L'C PCC v1IxCU rvR SIGNED TE % Z_ DEPARTMENT USE ONLY Application Accepted By � L _ Date IZIOZA?l Area `I o Employee ID# Final Inspection By lri t., �; S [U � 6- �u Z Date J�Z-7/Z V 1Z ❑ SPECIAL PERMIT -Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS & RO A Ni F r_ PE Code SC INFO Received By hec Amount Remitted Date Permit/ Service Request # Invoice # Permit ID# L-]al1 1I% *S9 i2-12121 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18 T ISt