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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-REFUNDABLEPERMITCALL 209 953-7697 FOR INSPECTIONS 6E�XPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS -V� 12(P t �V y"fY"j �D- CITY/ZIP A-�--A Y�'L PO dj CLZo �1 CROSS STREET Go L-L-\t2 APN 4 Z 1-03 o--3 S- PARCEL SIZE ✓ q `V EL o OWNER NAME A I UV�L Ok"e-,— S I1JR t-, PHONE ('tyaCr�- T ra OWNER ADDRESS P-0 b CITY/STATE/ZIP YI`1y1n.�T"EC./�CA q'�3'3(0 CONTRACTOR L\V'C: DPW- &t�Vtn/V1a4rjMCA/'T(}L_ PHONE 3UC1-o3-1 T CONTRACTOR ADDRESS 40-1 W. o Aw- S-T` CITY/STATE/ZIP L-oD( CA 4, L.a /U LICENSE l..''.'C-42 -1 C-36 OTHER e CC_ NUMBER Z 1 S'I EXPIRATION DATE �' J U 2-2— WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y PERC TEST # ( BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION 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 ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) .............................................................---...._..--- .........._...._..._....I....-.....---....- ___.__._..._-........_...........---- --------- 7 ❑ LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ❑ FILTER BED WIDTH ft LENGTH ft DEPTH DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE 4 2024 ❑ MOUNDED WIDTH It LENGTH It DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE JVVI QUIN CL) ❑ SUMPS WIDTH ft LENGTH ft DEPTH HFdIT.. ENZAL DISTANCE To NEAREST WELL ft FOUNDATION It PROPERTY LINE ARTMENT ❑ 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 4M12UR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 2 953-7697 SIGNED- TITLE 016- DATE ( -Z Z 7777 ,D PARTMEN US ONLY Application Accepted B DateD Area Y/ "t"/ Employee ID# Final Inspection By e v 2 Date 2 V L� SPECIAL PERMIT-Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS PE Sc Received Ch Amount Permit' Code INFO Bv Remitted Date Service Request# Invoice# Permit ID# 14?177- -L- 5 9.2 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18