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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 -REFI IuneRI F PERMIT r Al 1 t7nQ1 "-1-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADORE__ I ^ =� A /' _ _ _ CITY/ZIPau w7 c-, C /`�' CROSS STREET I�UI,W,I�V/C L! J APN O I71 LI � ) Q PARCEL SIZEf-1, 0 I _ OWNER NAME �Li �"' /p JJ/' �C� j� PHONE OWNER ADDRESS LJc� I`�.i JY� CTTYMTATE/LP CONTRACTOR ' V 1"Ille"I PHONE CONTRACTOR ADDRESS t/ `T V..� lir cITYISTATEIZIP LICENSE -42 C-36 OTHER NUMBER S EXPIRATION DATE I T {� LV �- J `� WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y PERC TEST # BUILDING PERMIT # V LAND USE APPLICATION # TYPE OF WORK: x NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED /ALTERNATIVE REPLACEMENT OUT -0F -SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: IX RESIDENCE COMMERCIAL OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: t9 NUMBER OF EMPLOYEES: SEPTIC TANK TYPE/MFG CAPACITY UCS gal #OF COMPARTMENTS �y,, ' U GREASE TRAP TYPEIMFG CAPACITY gal # OF COMPARTMENTS('? DISTANCE To NEAREST: WELL 3fI r ft PROPERTY LINE ft FOUNDATION / ` ft , ❑ LIFT STATION SIZE TYPE OF PUMP O PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) /p LEACH LINES LEACHINGCHAMBERS #oF LINES LENGTH OF LINES _ ft ` DISTANCE TO NEAREST ��ii WELL C7 -DC i / ft FOUNDATION J6 It PROPERTY UNE J' 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 UNE 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 ,CI SEEPAGE PITS NUMBER r� WELL It FOUNDATION ft PROPERTY LINE ft WIDTH ft DEPTH It ( \ DISTANCE To NEAREST WELL r �� nn / ft FOUNDATION LYD , ft PROPERTY LINE J 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. I% f DEP ARTMENTUSE NLY lI ff% Application Accepted By! L-- Date a Area r Employee ID# V` Final Inspection By Date SPECIAL PERMIT - Approved by Character of Soil to Depth of 3 Ft: Pit/SUmp Soil Character: COMMENTS i�..„ ti?P,�,IY 7,Fr v('�vr1�,� �FP- yE�c� -- --- "-- "" "" Dat " """ Invoice # Permit ID# Code INFO B Cash Remitted Service Re u st # 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18