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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 IYUIN-MittUNU tAttSSLt r'tKMI 1. ' l JOB ADDRESS / W CROSS STREET OWNER NAM OWNER ADDRESS C n ,903-/0.91 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUE ICJ �+ CITY/ZIP F14 t AC -S C-%/0 � C-4 APN 1'j . t7 PARCELSIZE CITY/STATE/ZIP PHONE CONTRACTOR !tr ��f///�� -t[- �(- PHONE %�- Q'� ^may -J$- q CONTRACTOR ADDRESS J06 yp (5 � (�� CITY/STATE/ZIP ��/L�C� �` / � /S77 LICENSE ❑0C-42 111IC-361OTHER - NUMBER (6975� EXPIRATION DATE Dn 7 T 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 vrx nvorcL. r IWIVO - rL-crSoc a.rSL.L_ 1 cvt TITLE ez'b'A DATE DEPARTMENT USE ONLY/ AS Application Accepted BAADate Area ! �� Employee ID# Final Inspection By Date_0 ZL ❑ SPECIAL PERMIT -Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS So<--od u-," GvJe111yu - lY' SSP cZ46(' � 0 m g"yav PE Code SC INFO Received By WATER TABLE DEPTH: Amount Remitted ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # Invoice # BUILDING PERMIT # d 10 d D 0 D LAND USE APPLICATION # TYPE OF WORK: f NEW INSTALLATION F1 REPAIR/ADDITION ❑ ENGINEER DESIGNED /ALTERNATIVE REPLACEMENT ❑ OUT -0F -SERVICE SEPTIC SYSTEM ❑ DESTRUCTION INSTALLATION WILL SERVE: VRESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: ` NUMBER OF BEDROOMS: ,_3 NUMBER OF EMPLOYEES: SEPTIC TANK TYPE/MFG ¢%rj�L.. CAPACITY JI'll C1 gal # OF COMPARTMENTS_ ❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS DISTANCE To NEAREST: WELL 18 IN ft FOUNDATION ,5 I ft PROPERTY LINE ft LIFT STATION SIZE 5 ��(' `' "J"- TYPE OF PUMPr)jrAAC+,. ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) i6ct A►A � U- LEACH LINES I ❑ LEACHING CHAMBERS # OF LINES LENGTH OF LINES 6 ft DISTANCE TO NEAREST At ft FOUNDATION 10) It PROPERTY LINE JLC ft WELL fool ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ MOUNDED WIDTH ft LENGTH ft DEPTH It DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE 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 T 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 vrx nvorcL. r IWIVO - rL-crSoc a.rSL.L_ 1 cvt TITLE ez'b'A DATE DEPARTMENT USE ONLY/ AS Application Accepted BAADate Area ! �� Employee ID# Final Inspection By Date_0 ZL ❑ SPECIAL PERMIT -Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS So<--od u-," GvJe111yu - lY' SSP cZ46(' � 0 m g"yav PE Code SC INFO Received By Che ash Amount Remitted Dat Permit/ Service Request # Invoice # Permit ID# 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18