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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE -STOCKTON CA 95205-(209)46"420 IVUN-r[tr UNUAt$Lt Y'tHMI l L.ALL LUJ &0,1-/ 0&/ FOR INSPECTIONS LXPIRES T YEAR FROM DATE ISSUE/ JOB ADDRESS 2 S& L (7 CITY/ZIP �; GC,(! I , (A= CROSS STREET ukJ Cl APN, 2 j3 0 j PARCEL SIZE OWNER NAME��'^-" I '� / • O rI^"1 PHONE OWNER ADDRESS N ro"e CITY/STATEIZIP Z �/ CONTRACTOR a4 17� L� y-/ `I (uly�+nrO�J�FJ)(i 71 PHONE CONTRACTOR ADDRESS � . { IIL 7 ��cyr �1(.e/ J�[�I-Y��i, CITYISTATE/ZIP ff�+/!�W/� � C LICENSE )1.42 C-36 OTHER NUMBER 7 S EXPIRATION DATE ` WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y PERC TEST # 1 BUILDING PERMIT # LAND USE APPLICATION # _ TYPE OF WORK: NEW INSTALLATION REP AI R/ADDITION ENGINEER DESIGNED /ALTERNATIVE REPLACEMENT OUT-OFSERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: RESIDENCE COMMERCIAL 2 OTHER NUMBER OF LIVING UNITS: I NUMBER OF BEDROOMS: J NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPEIMFG CAPACITY gal # OF COMPARTMENTS ❑ GREASE TRAP TYPEIMFG CAPACITY gal # OF COMPARTMENTS DISTANCE TO NEAREST: WELL ft 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 ft DISTANCE TO NEAREST WELL 150 ! R FOUNDATION /O' ft PROPERTY LINE VO / 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 ❑ SUMPS WIDTH ft LENGTH It DEPTH It DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ DISPOSAL PONDS WIDTH ft LENGTH R DEPTH ft ! SEEPAGE PITS DISTANCE T NEAREST NUMBER WELL WIDTH ft FOUNDATION off- 14 ft PROPERTY UNE ft ft DEPTH o� / ft r�ty�`I- DISTANCET FOREST ,� WELL /60 ft FOUNDATION 4kft PROPERTY LINE d 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. LI DEPARTMENT US ONLY Application Accepted By L Date Area SEmployee ID#_ Final Inspection By %. , 1 L �F:� ��u A./ 5 Date s SPECIAL PERMIT -Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Changcter: COMMENTS tl>1C,%ierr�t�ne -ner — �i�13}1pL,� L.�e� ao rrmejn. PE SC Received Check#/ Amount Permit/I. Invoice # Permit ID# Code INFORemitted Service R uest# 2 -Y Ice.y 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18 Y ,FMFNr SFO c �NTY 4N -