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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 - CALL (209) 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS, CROSS STREET OWNER NAME_ OWNER ADDRE7 CITY/ZIP SC //�� APN e.2 1090.E PARCEL SIZESj I �% Q`� PHONE!94 —7,/ �7/5 CITY/STATEIZIP v/ 64. 15 2-10 CONTRACTOR V*%,Ir-C, ( aeAh[, �7uG�Kl�L PHON(w4v7 %� 3 3 � �l " CONTRACTOR ADDRESS 1I�{i CITY/STATE/ZIP LICENSE ❑ L C-42 ❑ ❑C-36 OTHER NUMBER 9�'//f 7 EXPIRATION DATE —�Aw WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT # AND USE APPLICATION # TYPE OF WORK: ❑ NEW INSTALLATION CI 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: El SFPTIr TANK TYPF/Mr, F 1 .APArITY I/�Cao l7al U nP C'.hMPARTMFNTS ❑ 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) MINIMUM 48 HOU NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL 209 953-7697 SIGNED TITLE Dw"'"-L DATE . 1;7- 2 j DEPARTMENT USE ONLY rMII ITIVImI Application Accepted G 0`-' Date ( V7 G� Area C G RIlmO O' Final Inspection Byr Date [ISPECIAL PERMI proved Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: I rr C MMENTS I n� S %f' NTY � 0 f4)A %�i►�/� 17V /0�i /'Z) 1910 An. A'ld �i� n L 3!lP r, �f?Yi .. ENVIRONMoNIAL T 'r -�I�Q-f'U�In� << C:� > . PE SC Received Check#/ Amount LEACH LINES ❑ LEACHING CHAMBERS # OF LINES LENGTH OF LINES ft INFO �/--� Cash Remitted Service Request # DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ FILTER BED WIDTH ft LENGTH co 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 L4NE ft ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NE T WELL ft AT` N ft PROPERTY LINE ft SEEPAGE PITS NUMBER WIDTH FOg .3 ft DEPTH 0 ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQ INC UNTY OR INANCE , STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. Q/a ma f �jC MINIMUM 48 HOU NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL 209 953-7697 SIGNED TITLE Dw"'"-L DATE . 1;7- 2 j DEPARTMENT USE ONLY rMII ITIVImI Application Accepted G 0`-' Date ( V7 G� Area C G RIlmO O' Final Inspection Byr Date [ISPECIAL PERMI proved Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: I rr C MMENTS I n� S %f' NTY � 0 f4)A %�i►�/� 17V /0�i /'Z) 1910 An. A'ld �i� n L 3!lP r, �f?Yi .. ENVIRONMoNIAL T 'r -�I�Q-f'U�In� << C:� > . PE SC Received Check#/ Amount Date Permit/ Invoice # Permit ID# Code INFO B Cash Remitted Service Request # co �i 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18