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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 GALL JOB ADDRESS / �� w CROSS STREET OWNER NAME YbZS---16191 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUE'49y/,1Cx. CITY` /ZIP APN O tJ 1 3=0c)4- PARCEL SIZE / PHONE 'Lol��%�� OWNER ADDRESS/ Sr✓/yl•Je/ / J CITY/STATE/+ZIP CONTRACTOR / �17/�i/JL l//�✓1/� �L'�J�G PHONE CONTRACTOR ADDRESS -A- ZeJ %%11//// CITY/STATE/ZIP ]O6-4 LICENSE C2 ❑ '' 7 C-36 OTHER NUMBER �r� YS____EXPIRATION DATE WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: ❑ PERC TEST # BUILDING PERMIT # TYPE OF WORK: NEW INSTALLATION REPAIR/ADC Coordinates X Y LAND USE APPLICATION # IN ENGINEER DESIGNED /ALTERNATIVE REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: kRESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: i ❑ SEPTIC TANK TYPE/MFG 'eFy/ Sf7r'-'rj CAPACITY % �!/y gal # OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG 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) 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. SIGNED Application Accepted By Final Inspection By Character of Soil to Depth of 3 Ft: COMM NTS 5ark loor Date Date Area Pit/Sump Soil Character: DATE ' VIZ 7— Z?�' Employee ID# PERMIT -Approved by PE Code SC INFO Received Bas Check#/ C � �I. LEACH LINES LEACHING CHAMBERS # OF LINES LENGTH OF LINES f 3�� DISTANCE TO NEAREST WELL %d r ft FOUNDATION /G I ft PROPERTY LINE J0 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 ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft SEEPAGE PITS NUMBER WIDTH 3G ft DEPTH ft DISTANCE TO NEAREST WELL " ft FOUNDATION JD � ft PROPERTY LINE %o 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. SIGNED Application Accepted By Final Inspection By Character of Soil to Depth of 3 Ft: COMM NTS 5ark loor Date Date Area Pit/Sump Soil Character: DATE ' VIZ 7— Z?�' Employee ID# PERMIT -Approved by PE Code SC INFO Received Bas Check#/ Amount Date Remitted Permit/ Service Request # Invoice # Permit ID# 3�� 69 V 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18