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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-KEFUNDABLEE PERMIT J� / GALL LU,4UDJ-r0yr FOR INSPECTIONS I t=XPIRES l YEAR FROM DATE ISSUEI JOB ADDRESS 977 y/S, 11(.(l !J� Gi� CITY/ZIP `] 57 ��f�1O11� (-� C CROSS STREET �I hoe.,/ jj(�r APN ��c7I300 / PARCEL SIZE OWNER NAME r_)q je 6/ k)b,5 PHONE OWNER ADDRESS /CITY/STATE/ZIP ']� T� CONTRACTOR ! l I __ -1_- PHONE /y" / �+ G� //111120-1;) /0� CONTRACTOR ADDRESS / � (VC(Y A/t fir), u CITY/STATE/ZIP LICENSE ❑XC -42 111IC-36 OTHER NUMBEREXPIRATION DATE 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 X, REPLACEMENT 6!447 6a_f OUT -OF -SERVICE SEPTIC SYSTEM ❑ DESTRUCTION INSTALLATION WILL SERVE: qRESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: ♦ NUMBER OF BEDROOMS:i:��) NUMBER OF EMPLOYEES: TERNATIVE ❑ ❑ ❑ SEPTIC TANK GREASE TRAP LIFT STATION TYPE/MFG <C'474j TYPE/MFG DISTANCE TO NEAREST: WELL It✓ ft 3b! ' SIZE TYPE OF PUMP CAPACITY gal # OF COMPARTMENTS CAPACITY gal # OF COMPARTMENTS FOUNDATION �O ft PROPERTY LINE o7O ft ' ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) aio LEACH LINES 1� LEACHING CHAMBERS �� 2i S 80 # of LINES /� L LENGTH OF LINES i D0-,��6' x / DISTANCE TO NEAREST WELL P4b!/ C ft FOUNDATION IS" / ft PROPERTY LINE / 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 N^�EAREST WELL ft FOUNDATION ft PROPERTY LINE ft XSUMPS WIDTH c; ' ft LENGTH I q / ft DEPTH /Q .1 ft DISTANCE TO NEAREST WELL r `+ C. ft FOUNDATION 5-5-" ft PROPERTY LINE S ft ❑ 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. DEPARDTaMEBN 6 IE ONLY Area "1 Employee ID# v Application Accepted By I� Final Inspection By Q , m'%nuj Date V `�(] { �I ❑ SPECIAL PERMIT - Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS Ic.cN I1'nPS or 0'e �"le i, Lec�c,j� IineS iJeN ClO be (�F 1�1 s6oi�:� INOt )OC r1VP0-eV �har► `1a ;nc>nes st(,!l brave d FYr F e�' rock 07 Pr wise Desk'' �-prr�e�i1 PE Code SC ReceivedCheck INFO B sh Amount Remitted Permit/ Dat Service Request # Invoice # Permit ID# aio 11s ::oo �� 2i S 80 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18