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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 PERC TEST #_BUILDING PERMIT # CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUEI JOB ADDRESS REPAIR/ADDITION CiTTrYIZjJP/� REPLACEMENT •moi CROSS STREET —�4 �1 -1 I / l� • APN O 96-1 O`' / V PARCEL SIZE ONNERNAME J_j1Q'/YIInG. 3 So4�i�Iln De,,lTe, PHONE OVMER ADDRESS SGwle ' gal # OF COMPARTMENTS CITYISTATEIZIP CAPACITY gal # OF COMPARTMENTS /-�I / �0 /� /y' �% '7' — �� CONTRACTOR "[. ` li PHONE y — / .T �/ J"rj7 / CONTRACTORADDRESS J / f,(� MOUNDED �h�/ ��% Vr' CITYISTATE/LP /�lK (.Ar//�A ORR LICENSE C-42 C-36 OTHER ft DEPTH ft NUMBER �i5� /S DATE %64 /V WELL XPIRAT10N ft PROPERTY LINE ft 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: I NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPEIMFG �TI J 'y CAPACITY gal # OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS DISTANCE TO NEAREST: WELL fl FOUNDATION ft PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT O SAND OIL SEPARATOR (ENCLOSED SYSTEM) 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. Z_' DE PARTM NT S ONL L Application Accepted By L- Date Area —i I Employee ID# FrG►n k Final Inspection By �i7c�c.5 (a +.!%c, iLLM 2 Date 7 2.` SPECIAL PERMIT -Approved by Character of Soil to Depth of113 Pt: PittSump Soil Character: COMMENTS(IY1C�e7e/WL/h8 �T�er _ �XIs�Y►K+�F.Sgy,yn �earlte Invoice # PermitID# 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18 / t LEACH LINES LEACHING CHAMBERS # OF LINES ENGTH OF LINES Zo ft DISTANCE TO NEAREST }� WELL r U Cl R FOUNDATION /Q" llllllft PROPERTY LINE S, R ❑ FILTER BED WIDTH I ft LENGTH .900 It DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE ft ❑ SUMPS WIDTH It LENGTH It DEPTH ft DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE It ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft �J 00 SEEPAGE PITS DISTANCE TO EW ST NUMBER P WELL WIDTH ft FOUNDATION 'A Ca ft PROPERTY LINE ft It DEPTH t 45 ~ It (( �� DISTANCE TO AREST WELL ?yaj G It FOUNDATION It PROPERTY UNE It 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. Z_' DE PARTM NT S ONL L Application Accepted By L- Date Area —i I Employee ID# FrG►n k Final Inspection By �i7c�c.5 (a +.!%c, iLLM 2 Date 7 2.` SPECIAL PERMIT -Approved by Character of Soil to Depth of113 Pt: PittSump Soil Character: COMMENTS(IY1C�e7e/WL/h8 �T�er _ �XIs�Y►K+�F.Sgy,yn �earlte Invoice # PermitID# 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18