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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 NUN-KEhUNUABLE PERMIT (:ALL ZUY Y0J-/05/ FOR INSPECTIONS/ EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS C% %Elt//�jL% �� CITY/ZIP L47NQOP 95330 CROSS STREET APN 2 / 311190 �K PARCEL SIZE /J/77 OWNER NAME_ 4 lee - 15'MNc� S V LT -to / ^ yT/l PHONE OWNER ADDRESS / kJ CL Z CITY/STATE/ZIP h/eop el- CONTRACTOR 141E �j,�1S VG %(O IU Wc- PHONE /IP/6 -d yo^y'3oj CONTRACTOR ADDRESS /(/ /4 E 4L-,— Tge.-w Z� CITY/STATE/ZIP Aljg4a£-4/ GL'i IrS33 �i LICENSE ❑l IC -42 ❑CIC -36 OTHER A NUMBER / zZo EXPIRATION DATE ��/30�{%� WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION I REPAIR/ADDITION ENGINEER DESIGNED /ALTERNATIVE REPLACEMENT ( OUT -0F -SERVICE SEPTIC SYSTEM // DESTRUCTION acJ�%/L 'J74N% INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPE/MFG ❑ GREASE TRAP TYPE/MFG CAPACITY CAPACITY DISTANCE TO NEAREST: WELL ft FOUNDATION _ ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ LEACH LINES LEACHING CHAMBERS gal # OF COMPARTMENTS gal # OF COMPARTMENTS ft PROPERTY LINE ft ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) # OF LINES LENGTH OF LINES ft ft ft ft ft PROPERTY LINE DEPTH ft PROPERTY LINE DEPTH ft PROPERTY LINE DEPTH ft PROPERTY LINE DEPTH ft PROPERTY LINE DEPTH ft PROPERTY LINE 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. MINIMUM 48 HOUR ADVA E NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL 209 953-7697 SIGNEDTITLE DATE 5A-9 2 J / DEPARTMENT US ONLY .Irfo Application Accepted By Date 191a 0a Area 3 �pl� Employee ID# /�15 Final Inspection By fi<<g,r, �011r l `a Date �'j31�29� ❑ SPECIAL PERMIT -Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS Ddrvw 4S4 s}rudure Va" nan-rebAw —su'wC PE F� i,tllvlDilcr) di'Pw S l{ Anr (9 t �h ��3r/22 PE Code DISTANCE TO NEAREST WELL Check#/ Cash ft FOUNDATION ❑ FILTER BED WIDTH ft LENGTH o5- j DISTANCE TO NEAREST WELL - ft FOUNDATION ❑ MOUNDED WIDTH ft LENGTH DISTANCE TO NEAREST WELL ft FOUNDATION ❑ SUMPS WIDTH ft LENGTH DISTANCE TO NEAREST WELL ft FOUNDATION ❑ DISPOSAL PONDS WIDTH ft LENGTH DISTANCE TO NEAREST WELL ft FOUNDATION ❑ SEEPAGE PITS NUMBER WIDTH DISTANCE TO NEAREST WELL ft FOUNDATION ft ft ft ft ft PROPERTY LINE DEPTH ft PROPERTY LINE DEPTH ft PROPERTY LINE DEPTH ft PROPERTY LINE DEPTH ft PROPERTY LINE DEPTH ft PROPERTY LINE 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. MINIMUM 48 HOUR ADVA E NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL 209 953-7697 SIGNEDTITLE DATE 5A-9 2 J / DEPARTMENT US ONLY .Irfo Application Accepted By Date 191a 0a Area 3 �pl� Employee ID# /�15 Final Inspection By fi<<g,r, �011r l `a Date �'j31�29� ❑ SPECIAL PERMIT -Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS Ddrvw 4S4 s}rudure Va" nan-rebAw —su'wC PE F� i,tllvlDilcr) di'Pw S l{ Anr (9 t �h ��3r/22 PE Code SC INFO Received By Check#/ Cash Amount Remitted Date I Li Permit/ Service Reques # Invoice # Permit ID# ani o5- j lsa - 42-01Ole:I� nuql5l ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18 T