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9 c 7 7 ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 NON-KEFUND/ABLE HERMIT /w t� C:ALL LUU 40,5-f 01Y/ FUR INSPECTIUNS CXPIKLS "I T LAK FKUM L/A 1 t ISSUtl JOB ADDRESS 1 1GA� i Jan L 4 A -C, CITY/ZIP Lj' Cd CROSS STREET V., C L SY- R y� APN O �i e313 o3 a PARCEL SIZE �V OWNER NAME --T* irl �S 3 Sh L' / R ec C- FC '✓ r('� PHONE OWNER ADDRESS - Q CITY/STATE/ZIP CONTRACTOR M, kiq,* ex L ata J S� _i^ PHONE CONTRACTOR ADDRESS ion /n szc� CITY/STATEIZIP ��s� •� / G -A- LICENSE ❑❑C-42 1111C-36 OTHER NUMBER $SS EXPIRATION DATE WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # TYPE OF WORK: ❑ NEW INSTALLATION REPAIRIADDITION ❑ ENGINEER DESIGNED /ALTERNATIVE ❑ REPLACEMENT ❑ OUT -OF -SERVICE SEPTIC SYSTEM ❑ DESTRUCTION INSTALLATION WILL SERVE: VRESIDENCE ❑ COMMERCIAA., ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPE/MFG ❑ GREASE TRAP TYPE/MFG CAPACITY CAPACITY DISTANCE TO NEAREST: WELL ft FOUNDATION ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT gal # OF COMPARTMENTS gal # OF COMPARTMENTS ft PROPERTY LINE ft ❑ 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 l :-ti ti a LklYti-' L Date L Z ❑ SPECIAL PERMIT -Approved by Character of Soil to Depth f 3 Ft: Pit/Sump Soil Character: COMMENTS Uy�, +,et ))'-( ;elr L N )- erml 'gjre' tceo )r lf"6d' llbrs are t r be-" n ne&—' if .6t " C"t' lct• PE Code SC INFO Received Chec B ash I Er LEACH LINES ❑ LEACHING CHAMBERS Permit ID# # OF LINES _ _ LENGTH OF LINES 6 b© ft DISTANCE TO NEAREST WELL 7Sti - It FOUNDATION got ft PROPERTY LINE 7 S 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 11 1 ft DEPTH_ 'it) ft DISTANCE TO NEAREST WELL ft FOUNDATION (6(3/ ft PROPERTY LINE SQA 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. Final Inspection By l :-ti ti a LklYti-' L Date L Z ❑ SPECIAL PERMIT -Approved by Character of Soil to Depth f 3 Ft: Pit/Sump Soil Character: COMMENTS Uy�, +,et ))'-( ;elr L N )- erml 'gjre' tceo )r lf"6d' llbrs are t r be-" n ne&—' if .6t " C"t' lct• PE Code SC INFO Received Chec B ash Amount Remitted Date Permit/ Seryice Re uest # Invoice # Permit ID# Ll a)Ll30o S . 22 S' IN -),9C>02 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18