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w ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 NON-REFUNDABLE PERMIT 'J (:ALL ZUFOR INSPECTIONS tXPIRES l YEAR FROM DATE ISSUEI JOB ADDRESS ZMS-Z V3 (► *k6-&%0�.IA ?L► CITY/zip'w IP Acwz (Jo �) ZZ0 CROSS STREET 0 L- V er rr J APN ()D!;-- '400 - 0 J PARCEL SIZE Z' 0 OWNER NAME MAO-Vt.LC�) FV - PHONE 400 7.(00- (OSl I OWNER ADDRESS SA &%(: CITY/STATE/ZIP CONTRACTOR l,l-,)t O,,ft1Lw- &WCWVNepNW1E� Kl� PHONE ffT3(nq- 0311 C-^ QT'-) CONTRACTOR ADDRESS 0, 'a�� I CITY/STATE/ZIP Lo)>t -`' �( TO LICENSE ...1 C-42 ❑ r? ^ C-36 OTHER ` '-� NUMBER E%PIRATION DATE 44 -3 0 - -4-2- WATER Z WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y /" PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # TYPE OF WORK: ! ; NEW INSTALLATION REPAIR/ADDITION i . ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: RESIDENCE ❑ 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 DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE It ❑ LIFT STATION SIZE TYPE OF PUMP O PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) ❑ LEACH LINES LEACHING CHAMBERS # OF LINES LENGTH OF LINES ft DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft ❑ MOUNDED WIDTH It LENGTH it DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ SUMPS WIDTH It LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL It 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 a 4QUR ADVANCE NOTICE RE IRED FOR INSPECTIONS - PLEASE CALL 209) 953-7697 SIGNED TITLE AZOJ . V4G2• DATE 7--f— Z2 PAYIfi9ERli �+DEPARTMENT US.E ONLY / FR— Final Application Accepted By !✓ _ Date a as Area / Employee ID# Inspection By 6".f, 04"', Date 7/10'27- SPECIAL PERMIT -Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS PE Sc Received Check#/ Amount D to Permit/ Invoice # Permit ID# Code INFO B Cash Remitted Service Request # 4;Q R 1;-'a3► S -a 2 �- 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18 ECEIVED B 0 2 20?7 OAQUIN COUNTY VIRONMENTAL TH DEPARTMENT