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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-REFUNDABLE PERMIT V G-7A-L�Ly�2U9 953-7657 FOR INSPECTIONS o tXPIRES l YEAR FROM DATE ISSUEI JOB ADDRESS .3252-1 5- IKOS CLQ CITY/ZIP T1(�-'�y ��3oT CROSS STREET ST _ II ' . q33 3 �, r� ,APNN 2 S� - Z T PARCEL SIZE 31-33 Ar - OWNER NAME , t -F Pt-NGt-LfA LA`' `LAG. PHONE 4'11 ( - 5-1 12-1 OWNER ADDRESS C/D C At�L ^/AVA7tRA 4-15 LO ' $LE41E TCITY/STATE/ZIP 'r(2 Ci -q C -A 11� rV 4 CONTRACTOR �-1 � E S�TCJJ D O aIL N &EOEVI0-0-rj ►'� Ey I1Ik L PHONE ?(Oct ' O3-1 S CONTRACTOR ADDRESS I "• PCS= ST - CITY/STATE/ZIP L -OD( CpR `�Z'�� LICENSE C-42 O[ C-36 OTHER C e NUMBER 2 -IT -1 ERPIRATION DATE q-30-7-7- WATER 'lI~SV-ZZ' WATER TABLE DEPTH: It GEOGRAPHICAL INFORMATION: Coordinates X Y PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION I ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM I..'. DESTRUCTION INSTALLATION WILL SERVE: RESIDENCE 11 COMMERCIAL _' OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPEIMFG CAPACITY 981 # OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS DISTANCE TO NEAREST: WELL R FOUNDATION ft PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) ❑ LEACH LINES LEACHING CHAMBERS # OF LINES LENGTH OF LINES It DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE It ❑ FILTER BED WIDTH It LENGTH ft DEPTH It DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE It ❑ MOUNDED WIDTH ft LENGTH ft DEPTH It DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ SUMPS WIDTH It LENGTH PARCEL"3" ft DEPTH ft DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH If DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE It 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. MINIMUM48HDIIR ADVANCE NOTICE RE 1 FOR INSPECTIONSn - PL A E ALL 2 -7 7 SIGNEDM/Q TITLE QJ - /Yt•'(7'� • DATE (0-4-2,1 if NIITFII( I III SECIIOII lWE \ tMV/A�A FIIIM1YtLLC '�i I SBY10'S2w i812A2• $$ I I I I BBOI052w , E (S2% DETAIL 'B-) E' X saB•se•nw zel3.ss' I ill 255-100-28 1 - � N4V/JtRA FIl11LY LLC 1 .1 � 9 DEPARTMENT U SE ONLY Application Accepted Q(�y L�L� Data )01/vl Area Employee ID#_ As Final Inspection By 11 - Date 1Sl r] SPECIAL PERMIT - Approved by Character of Soil to Depth of 3 Ft: P ump Soil Character: COMMENTS PE SC Received Check#/ Amount Permit/ Invoice # Permit ID# Code INFO vyx A Cash . Remitted Opte I Service Re u st # j'Raa sa isa I S 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18 AYMENT ECEIVED 1 8 2021 OAG)UIN COUNTY VIRONMENTAL TH DEPARTMENT "2"-:6 R 3ro.00' SB.ar- PARCEL PARCEL "f" ♦ 3a5.aB sesa's2w �3b5 � '� (sE[ 2..> scats 31B.ar 1"�ao•"�$ n,oNES�rz) seaa•s2w y EiNL -Aj 103 k o � Y Y g NB2'10'11•F 281 fi.10' ]] Nag m ' \ .2' �- 3]11.2 11 "DESIGNATED 36" �3M2'- REMAINDER" jyl� PARCEL"3" _ Y E (S2% DETAIL 'B-) E' X saB•se•nw zel3.ss' I ill 255-100-28 1 - � N4V/JtRA FIl11LY LLC 1 .1 � 9 DEPARTMENT U SE ONLY Application Accepted Q(�y L�L� Data )01/vl Area Employee ID#_ As Final Inspection By 11 - Date 1Sl r] SPECIAL PERMIT - Approved by Character of Soil to Depth of 3 Ft: P ump Soil Character: COMMENTS PE SC Received Check#/ Amount Permit/ Invoice # Permit ID# Code INFO vyx A Cash . Remitted Opte I Service Re u st # j'Raa sa isa I S 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18 AYMENT ECEIVED 1 8 2021 OAG)UIN COUNTY VIRONMENTAL TH DEPARTMENT