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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT 'SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENDF -RTnPI 1. PA ar,n� _ 1-1 eco *A- NON-REFUNDABLuE LP/ERMIT CALL (209) 953-7697 FOR INSPECTloNS EXPIRES 1 YEAR FROM DATE ISSU JOB ADDRESS —5 I 1 �SC-CyZ/ET>•t _l.ry ��}'/` CITr(2'1�P�/11oz�+� el / R52I"Z �( G� CROSS STREET f lh AM 5(-' l /M✓F _ APN e2 } -190 - �- f PARCEL SIZE _�_ OWNERNAME DFcfJ VCIZ r<•Z 11 PHONE OWNER ADDRESS .5 •✓Je�- CITY/STATE/ZIP 1 CONTRACTOR '2�5 C'oNSTkI.ItTSa n7 3 SGiTrG, Tix PHONE' 111' CONTRACTOR ADDRESS -'�;7-277`rloR/rtsciJ C«IG .7(� Sri �' 2�+ip CRY/STATE/ZIP S.OLtZL}y�r ��P.J��.SQ�g LICENSE x-42 C-36 OTHER NUMBER f22136- EXPIRATION DATE(. WATERT GRIL I War— xT - I t, ❑ PERC TEST TYPE OF WORK: �__....•.. .......�n. ..mni vn. �w Hca � Y BUILDING PERMIT # LAND USE APPLICATION # NEW INSTALLATION REPAIR/ADDMON ENGINEER DESIGNED /ALTERNATIV I� REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION � _ _ INSTALLATION WILL SERVE: V RESIDENCE ❑ COMMERCIAL ❑ OTHER_ NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: 3ffj,jL"UMBER 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 R L3 LIFTSTATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) LEACH LINES LEAC HINGCHAMBERS�iVrslaRirroR 2 #OFLINEs LENGTH OF LINES -541' ft DISTANCE TO NEAREST WELL 1190 , ft FOUNDATION 2 S ft PROPERTY LINE ❑ FILTER BED WIDTH ft LENGTH It DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL it FOUNDATION ft PROPERTY LINE ft ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ DISPOSALPONDS WIDTH It LENGTH It DEPTH ft ' / DISTANCE TO NEAREST WELL �L_ ft FOUNDATION ft PROPERTY LINE ft I7 SEEPAGE PITS NUMBER WIDTH 40 .� ft DEPTH 2�I ft DISTANCE TO NEAREST WELL 15a ft FOUNDATION 2 S • ft PROPERTY LINE 20` _ 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. U C t - AHI Mt N/ UZ5t UNLY / Application Accepted Beyi; ii/' // p Date Area =>� " Employee ID#�r Final Inspection By_A l / ��/ �(%jj fi � Date / 1:I 1 SP IAL PERMIT - Approved by Character of Sail to Depth of 3 Fti_ ------ Pf�mp Character: COMMENTS (� �IA,i1dLTCJ_�� (zl ( S `�' 42-01 �,C -Y1 )( �I T �T� 3 l� ��> ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18