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s Ar ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 NUN-MLIUNUABLE PEJjR�JMIT (:ALLr ZUyJ YDJ-/6y/ FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUEI JOB ADDRESS L9 .!n t/ f C U 'S CIITY//ZI`P� If f CROSS STREET fah L� 919 7 APN 0d ),2 ) Q d / PARCEL SIZE �'O' b OWNER NAME 1O �I C' In 0 ' p �I PHONE OWNER ADDRESS V ox 3d F CITY/STATE/ZIP ^ � CONTRACTOR �j/j�%Cf� PHONE 2e, -i — �ct��-s-o ;,,7a/wry CONTRACTOR ADDRESS -(l 1. �W/4e„, , / �i� 1✓�� CITY/STATE/ZIP LICENSE ❑X42 ❑CIC -36 OTHER NUMBER 1/5 EXPIRATION DATE Z WATER TABLE DEPTH: 1 J0 _) LI o ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT # a) O a7 I D LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION 0 REPAIR/ADDITION [7 ENGINEER DESIGNED /ALTERNATIVE ❑ REPLACEMENT ❑ OUT -OF -SERVICE SEPTIC SYSTEM ❑ DESTRUCTION INSTALLATION WILL SERVE: RESIDENCE ElCOMMERCIA ) ❑ OTHER NUMBER OF LIVING UNITS: - (- NUMBER OF BEDROOMS: 3 / ate} NUMBER OF EMPLOYEES: SEPTIC TANK TYPE/MFG t_ //�� (!J ” /I CAPACITY /�/ `/O gal # OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS DISTANCE TO NEAREST: WELL ft FOUNDATION f o ft PROPERTY LINE 60 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. SIGNED DATE ' 4 l DEPARTMENT USE ONLY Application Accepted By --�= L/ I(—'— Date? ? Area L� "/ Employee ID# F P, Final Inspection By Date , Z-( ❑ SPECIAL PERMIT -Approved by Character of Soil to Depth 3 Ft: Pit/Sump Soil Character: COMMENTS �,j S F PE Code LEACH LINES L LEACHING CHAMBERS ,-aec_W Amount Remitted # OF LINES 3) / LENGTH OF LINES 515 ft / Permit ID# DISTANCE TO NEAREST WELL o lam' r� ft FOUNDATION 30 , ft PROPERTY LINE 0 / ft ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL _42+_ 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 TO NEAREST WELL NUMBER -3 WIDTH ft %2 FOUNDATION // ft ft PROPERTY LINE ft / DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE V 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. SIGNED DATE ' 4 l DEPARTMENT USE ONLY Application Accepted By --�= L/ I(—'— Date? ? Area L� "/ Employee ID# F P, Final Inspection By Date , Z-( ❑ SPECIAL PERMIT -Approved by Character of Soil to Depth 3 Ft: Pit/Sump Soil Character: COMMENTS �,j S F PE Code SC INFO Received By ,-aec_W Amount Remitted Date Permit/ Service Request # Invoice # Permit ID# ya i i W7 till �'al _42+_ 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18