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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 CALL Z09 V 3 -769Z FOR INSPECTIONS EXP] S 1 YEAR FROM DATE ISSUE] JOB ADDRESS �S s— acedCITY/ZIP Q O l CROSS STREET I ' �r�nSl /� CJC(/J Q APN O�ZC1 v V� V PARCEL SIZE `I OWNER NAME �� F -C Y� L7 C4 ��PHONE OWNER ADDRESS �e /f CITY/STATE/ZIP CONTRACTOR V K C PHONE CONTRACTOR ADDRESS 1*'1 '41-C /_/(1 CITY/STATE/ZIP 74 e- IIE, 10ki LICENSE ❑)I _42 01 -IC -36 OTHER NUMBER 10 05 EXPIRATION DATE �— '.)Cap3 WATER TABLE DEPTH: 7(D G ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # TYPE OF WORK: ❑ NEW INSTALLATION REPAIR/ADDITION I-! ENGINEER DESIGNED /ALTERNATIVE 17 REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM , DESTRUCTION INSTALLATION WILL SERVE: RESIDENCE E COMMERCIALL3 G OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPE/MFG !- / 5M CAPACITY gal # OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG J CAPACITY gal # OF COMPARTMENTS WELL L( L ft DISTANCE TO NEAREST: WELL ft FOUNDATION 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. Final Inspection By �Df4 �,� 1 _ Date 2L�- Z Z. ❑ SPECIAL PERMIT -Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS // Lief 1 bc,�yl(�o►��hc: 1977 11Nres P'�S r YntEIN ��. l;v►Ps bCl>7� 1-P nla[.PK/ s ► )t)t I hlP rlio vo N Ic r.i In !✓yw' PC . -2 L � i rn�liiPt ,r, ✓ter".!r• ,.vii•%✓ bir,-P ,� �; So I PS PE Code LEACH LINES LEACHING CHAMBERS # OF LINES LENGTH OF LINES 3 ft jJ5 2`f�3( DISTANCE TO NEAREST WELL L( L ft FOUNDATION jD".ble' ft PROPERTY LI ft ❑ FILTER BED WIDTH ft LENGTH ft DEPTH a6 0 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 SEEPAGE PITS DISTANCE TONEAREST � NUMBER ) WELL ft WIDTH 3 FOUNDATION k J/ ft ft PROPERTY LINE ft DEPTH Q 571# ft (� DISTANCE TO AREST WELL -a&'( ft FOUNDATION (g, ft PROPERTY LINE .90 I 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. Final Inspection By �Df4 �,� 1 _ Date 2L�- Z Z. ❑ SPECIAL PERMIT -Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS // Lief 1 bc,�yl(�o►��hc: 1977 11Nres P'�S r YntEIN ��. l;v►Ps bCl>7� 1-P nla[.PK/ s ► )t)t I hlP rlio vo N Ic r.i In !✓yw' PC . -2 L � i rn�liiPt ,r, ✓ter".!r• ,.vii•%✓ bir,-P ,� �; So I PS PE Code Sc INFO Received Chec Bv Cash Amount Date Permit/ Invoice # Permit ID# Remitted Service Request # )0 jJ5 2`f�3( 3v0 I 22 S�D� 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18