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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-KEFUNDABLE PERMIT (;ALL (ZU.9) Yb3-/6y/ FOR INSPECTIONS (� LXPIREES I YEAR FROM DATE ISSUEI JOB ADDRESS 16 D g )X/j Abjl�I� J CITY/ZIP t94 fr CROSS STREET 6;, -,IL /w.J/�L�.? APN 3 o y a a PARCEL SIZE OWNER NAME Q+� f7 ��r/� // �Z✓ i PHONE:2-01 OWNER ADDRESS i 0 CI 9 a1 //''E 1 iJ/IWe / CITY/STATE/nZIP�J��i CONTRACTOR L� ,G/ j rUf1/�Zn)��1/( 1� PHONE �✓,�'`J TsJ?� �z CONTRACTOR ADDRESS/ U� ' /7^/T ��J CITY/STATE/ZIP / d/// !/� LICENSE ,(60C-42 ❑0C-36 OTHER NUMBER. 66- b� EXPIRATION DATE WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION ❑ PERC TEST # BUILDING PERMIT # TYPE OF WORK: ❑ NEW INSTALLATION REPAIR/ADI Coordinates X Y LAND USE APPLICATION # iN ❑ ENGINEER DESIGNED M ❑ REPLACEMENT ❑ OUT -OF -SERVICE SEPTIC SYSTEM X DESTRUCTION 1 L1 1 K INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: TERNATIVE " SEPTIC TANK TYPE/MFG /- CAPACITY ��y� gal # OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS ❑ DISTANCE TO NEAREST: WELL ft FOUNDATION �L ft PROPERTY LINE ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) MAWUM 48 UR DVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL los 953-7691 SIGNED //A TITLE G'/ Q DATE `�5_ i L Application Accepted By Final Inspection By Character of Soil to Depth o 3 COMMENTS P (Je le been e N1GouYi4efed c // DEPARTMENT U E ONLY Z__ Date L/ a oZ Area Employee ID# f GI ✓1 6 Date ! ,- ❑ SPECIAL PERMIT -Approved by pit/Sump Soil Character: : -fib Ir {�n�iYi t/er1�'v GO -0 sail has PE SC Received Check#/ Amount Code INFO B Cash Remitted __j ;l)C I)S Ej-75: oob Date Service it/ Invoice # I Permit ID# ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 42-01 4/14/18 LEACH LINES ❑ LEACHING CHAMBERS 1 #OF LINES _ LENGTH OF LINES ft R DISTANCE TO NEAREST WELL ��/ , ft LLV FOUNDATION %%% l�' ft PROPERTYLINE ,7� �- 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 NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ISI SUMPS WIDTH j' ft LENGTH ) ft DEPTH A ft \ DISTANCE TO NEAREST WELL ft j FOUNDATION L'- ft PROPERTY LINE } ft ❑ DISPOSAL PONDS WIDTH l 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, A STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. MAWUM 48 UR DVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL los 953-7691 SIGNED //A TITLE G'/ Q DATE `�5_ i L Application Accepted By Final Inspection By Character of Soil to Depth o 3 COMMENTS P (Je le been e N1GouYi4efed c // DEPARTMENT U E ONLY Z__ Date L/ a oZ Area Employee ID# f GI ✓1 6 Date ! ,- ❑ SPECIAL PERMIT -Approved by pit/Sump Soil Character: : -fib Ir {�n�iYi t/er1�'v GO -0 sail has PE SC Received Check#/ Amount Code INFO B Cash Remitted __j ;l)C I)S Ej-75: oob Date Service it/ Invoice # I Permit ID# ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 42-01 4/14/18