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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-REFUNDABLE PERMIT (:ALL (ZU9) 9b3-76'J7FOR INSPECTIONS CXPIRES 1 YEAR FROM DATE ISSUEI JOB ADDRESS -Z6PO f7 to • rA q AJ V EL S I Ly A CITY/ZIP AcC 0'k W't PO '15-7 --' Q CROSS STREET 5 P r s s APN 009- ' 3 S O - I) Lo PARCEL SIZE 2 ' 03 Ar OWNER NAME J y V P� LLC PHONE - 2 23 OWNER ADDRESS S OA ` CITY/STATE21P CONTRACTOR L I J IC C Ac K PHONE 3 y- 037 S CONTRACTOR ADDRESS 401 w I` ST ' CITY/STATE/ZIP t- 0� I C A LICENSE Li.]C-42 ❑L.1C-36 OTHER C e-7% NUMBER -2- I S ( EXPIRATION DATE 4-30--414 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/ALTERNATIVE .... REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM ❑ DESTRUCTION INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPE/MFG 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. i LEACHING CHAMBERS ft PROPERTY LINE # OF LINES It DEPTH DISTANCE TO NEAREST WELL ft If FOUNDATION_ ❑ FILTER BED WIDTH ft LENGTH It ft PROPERTY LINE DISTANCE TO NEAREST WELL I ft FOUNDATION ❑ MOUNDED WIDTH ft LENGTH NFA,C lI 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 LENGTH OF LINES ft ft PROPERTY LINE it It DEPTH ft ft PROPERTY LINE ft ft DEPTH ft ft PROPERTY LINE r l ft DEPTH It ft PROPERTY LINE ft DEPTH I ft PROPERTY LINER ft DEPTH 1. ft PROPERTY LINE NFA,C lI 1 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 UOUR ADV CE NOTICE REQUIRED FOR INSPECTION - PLEASE CALL 53-7697 SIGNED TITLE PlLdi ' til CrIL DATE -4 - ` 4 -22- ft. Ci 22- DEPARTMENT U E ONLY Application Accepted By �� G �J� Date qJ912a Area -I / G Employee ID# F rt Final Inspection By 'Efun..iw i., u.tra (Vn L Date SV -u- ❑ SPECIAL PERMIT -Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18 �� MENr E,VED R 0 4 ?022 QU/N co ON/01 pgRT FNr