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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-REFUNDABLEPER/MIT 7� DI/ 209) 953-7697 FOR INSPECTIONS/l j^ EXPIRES 1 YEAR FROM DATE ISSUED JOBADDRESS /� �/ ISF� 04' ,7j DI/G//r/fl0 C4 CITY//ZIP CROSS STREET ' ! Ow A-" APN_ 7-2719— 765' PARCEL SIZE OWNER NAME %� LY�/ L• PHONE � OWNER ADDRESS Z 3 c^ %o��(J'/�P JCO'/ A5�r CA CITY/STATE/ZIP 9S 22z5 CONTRACTOR Vu^ •, }—' bi l�v� �{— PHONE 9/6 1�/ .53 S1 CONTRACTOR ADDRESS CITY/STATE/ZIP LICENSE 1111C-42 ❑0C-36 OTHER NUMBER EXPIRATION DATE WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # 2103 BUILDING PERMIT # 2100 7 :2� 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 Ij ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: ` NUMBER OF EMPLOYEES: SEPTIC TANK TYPE/MFG �r CAPACITY V 0 gal # OF COMPARTMENTS_ r ❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS DISTANCE TO NEAREST: WELL _qD't7 ft FOUNDATION ft PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) SIGNED0'0- /T� TITLE DATE .5-18 2 PP p y��6.z DEPARTMENT S ONLYA lication Acce ted B Date Area Employee ID# Final Inspection By c :fit "S Z'.'l�—c .�r,2 Date % ❑ SPE IAL ERMIT -Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS%( PE LEACH LINES ❑ LEACHING CHAMBERS � # of LINES � LENGTH OF LINES _SU ft Amount DISTANCE TO NEAREST WELL :20-0 ft FOUNDATIONS ft PROPERTY LINE ft ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft as Remitted 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 SEEPAGE PITS DISTANCE TO NEAREST WELL ft NUMBER WIDTH �12� FOUNDATION ft PROPERTY LINE ft ft DEPTH 2�� ft DISTANCE. TO NEAREST WELL -2e)O ft FOUNDATION `Or ft PROPERTY LINE 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. MINIMUM 48 /IOUF?dADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209)953-7697 SIGNED0'0- /T� TITLE DATE .5-18 2 PP p y��6.z DEPARTMENT S ONLYA lication Acce ted B Date Area Employee ID# Final Inspection By c :fit "S Z'.'l�—c .�r,2 Date % ❑ SPE IAL ERMIT -Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS%( PE SC Received Check#/ Amount Permit/ Code INFO By as Remitted Date Service Request # Invoice # Permit ID# o4l-LLq- S I 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4114/18 a d d