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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-KEFUNDA LE PERMIT GALL ZUY YOJJ-/6J/ FOR INSPECTIONS .j, tXPIRES 'I YEAR FROM UATE ISSUEI JOB ADDRESS I., -2 �J 5, e I -i' tz rCITY/ZIP_/ 'Lr1/ , Ci� ��Qy CROSS STREET w �yv[ �J n� /I APN 95-a 1 � O —01' PARCEL SIZE / 0 S OWNER NAME Ru �`1 (-Q &-'/ i & i'.6 r"mI T 1q- (-�% [Ci PHONE OWNER ADDRESS Sr m e CITY/STATEIZIP CONTRACTORS cc�CG, C► / Sc % . PHONE e� CONTRACTOR ADDRESS A 6 �c _'grQ CITY/STATE/ZIP 01-ey. .r,-- Ar,G #f LICENSE [10C-42 ❑CIC -36 OTHER VA NUMBER&7d & EXPIRATION DATE PZ/� WATER TABLE DEPTH: �Q_SS + Ie ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT # Q LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION Fl REPAIR/ADDITION ❑ ENGINEER DESIGNED /ALTERNATIVE REPLACEMENT ❑ OUT -OF -SERVICE SEPTIC SYSTEM ❑ DESTRUCTION INSTALLATION WILL SERVE: ESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: I NUMBER OF BEDROOMS. -7 NUMBER OF EMPLOYEES: fd SEPTIC TANK TYPE/MFG y0 fl- CAPACITY [y� gal # OF COMPARTMENTS a ❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENiiTS� WIDTH DISTANCE TO NEAREST: WELL toot ft FOUNDATION S ( ft PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) LEACH LINES ❑ LEACHING CHAMBERS WELL fool ft ft LENGTH _ # OF LINES —3 LENGTH OF LINES ( 00 1 ft FOUNDATION 10 t" ft PROPERTY LINE J I ft ft DEPTH ft WELL DISTANCE TO NEAREST FILTER BED WIDTH ft PROPERTY LINE ft ft DISTANCE TO NEAREST MOUNDED WIDTH DEPTH ft WELL DISTANCE TO NEAREST SUMPS WIDTH ft PROPERTY LINE ft - ft DISTANCE TO NEAREST DISPOSAL PONDS WIDTH DEPTH ft WELL DISTANCE TO NEAREST SEEPAGE PITS NUMBER ft PROPERTY LINE ft _ ft DISTANCE TO NEAREST WELL fool ft ft LENGTH _ # OF LINES —3 LENGTH OF LINES ( 00 1 ft FOUNDATION 10 t" ft PROPERTY LINE J I ft ft DEPTH ft WELL SC INFO ft FOUNDATION Amount Remitted ft PROPERTY LINE ft ft LENGTH Permit ID# ft DEPTH ft WELL ft FOUNDATION ft PROPERTY LINE ft - ft LENGTH ft DEPTH ft WELL ft FOUNDATION ft PROPERTY LINE ft _ ft LENGTH ft DEPTH ft WELL ft FOUNDATION ft PROPERTY LINE ft WIDTH ft DEPTH ft 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. SIGNED OR INSPECTIONS - PLEASE CALL (209) 953-7697 TITLE Cb_lNj�% 944-r DATE DEPARTMENT USE ONLY ` Application Accepted By Z Date I I F Area S Employee ID#� Final Inspection By Date Z 2 ❑ SPECIAL PERMIT -Approved by Character of Soil to Depth of 3 Ft: �} it/ ump Soil Character: COMMENTS r�P\nl SFR. T)f-r1� SPo�ic f��v,I� �y 5�2Pr�Iy�'f SS/t1LS je.q*r 6F Con�/�rla�2s PE Code SC INFO Received B Chec as Amount Remitted Date Permit/ Service Request # Invoice # Permit ID# 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18