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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 VERMIT JOB ADDRESS CROSS STREET OWNER NAME IJ bF0J-f 0.V f FOR INSPEGTIONS C ✓•Q 4, te_ CITY/ZIP APN PHONE PARCEL SIZE OWNER ADDRESS CITY/STATE/ZIP / CONTRACTOR LJC �I �C� I L 14 �/pV74 C %� PHONE 2 - 3 , L-5 2- -0 T7 / 2aCONTRACTOR ADDRESS J / 1 lL T084 ��!� Cl/F/ CITY/STATE/ZIP �^r/�^' ' I d/g LICENSE ❑XC -42 110C-36 OTHER NUMBER ��7 7Q EXPIRATION DATE i WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT # qq LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED /ALTERNATIVE WELL ft ❑ REPLACEMENT ❑ OUT -OF -SERVICE SEPTIC SYSTEM ❑ DESTRUCTION INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: MBER OF BEDROOMS: NUMBER OF EMPLOYEES: SEPTIC TANK TYPE/MFG /' B CAPACITY OD gal # OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS FOUNDATION ft PROPERTY LINE ft DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE L-2ft ❑ 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 - FinalInspection By� Character of Soil to Depth COMMENTS DATE 'f — DEPARTMENT VSE ONLY Date Area Employee ID# Date�1 12z ❑ SPE IAL PERMIT -Approved by 3 it/Sump Soil Character: �%:� Ise � r r .%' �/✓iT//7 i^✓l �/`�r� I �� 7�� i �-� PE Code LEACH LINES ❑ LEACHING CHAMBERS Permit/ Invoice # Permit ID# Service -Request # # OF LINES ' LENGTH OF LINES �� ft DISTANCE TO NEAREST WELL ft FOUNDATION le�2 ft PROPERTY LINE 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 SEEPAGE PITS DISTANCE TO NEAREST NUMBER `'S7 WELL WIDTH ft FOUNDA ION ft PROPERTY LINE ft %L ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION / �i) 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. SIGNED Application Accepted By - FinalInspection By� Character of Soil to Depth COMMENTS DATE 'f — DEPARTMENT VSE ONLY Date Area Employee ID# Date�1 12z ❑ SPE IAL PERMIT -Approved by 3 it/Sump Soil Character: �%:� Ise � r r .%' �/✓iT//7 i^✓l �/`�r� I �� 7�� i �-� PE Code SC INFO Received Check#/ Amount Date j Cash Remitted Permit/ Invoice # Permit ID# Service -Request # AM 115 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18