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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-KEFUNDAB//LE PERMIT UALL LUY Y03-/tiblf FOR INSPECTIONS/ - EXPIRES /1 YEAR FROM DATE ISSUEI JOB ADDRESS /(O5Z P4%LAD1_'._— n%Zl� nP4i- C'ITT Y/ZIPnG�7HTZ0� CROSS STREET �ii�14D�� l� �IGI✓BL2 1S�4Ub Phu/ APN el_5 q7 ^ `d PARCEL SIZE OWNER NAME 12-IVe-z 15/�4Nd> Da.—✓a,,P,,,� PHONE OWNER ADDRESS 73 s Pai> CITY/STATE/ZIP C4 95330 CONTRACTOR /14L,907 (A-76_ PHONE g/,0 -11`9o -i30 % CONTRACTOR ADDRESS P.4'4- /¢ L' CITY/STATE/ZIP M A"re-_-4 G� lS33� LICENSE ❑I 'C-42 ❑CIC -36 OTHER y IJ NUMBER /0149958 EXPIRATION DATE —T� WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # TYPE OF WORK: 0 NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED /ALTERNATIVE i Cl REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM X DESTRUCTION INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPE/MFG ❑ GREASE TRAP TYPE/MFG DISTANCE TO NEAREST: WELL ❑ LIFT STATION SIZE TYPE OF PUMP ❑ LEACH LINES I LEACHING CHAMBERS CAPACITY CAPACITY ft FOUNDATION _ ❑ PKG TX PLANT # OF LINES gal # OF COMPARTMENTS gal # OF COMPARTMENTS ft PROPERTY LINE ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) DISTANCE TO NEAREST WELL ❑ FILTER BED WIDTH Permit/ Service Request # ft Permit ID# DISTANCE TO NEAREST WELL ❑ MOUNDED WIDTH ft DISTANCE TO NEAREST WELL ❑ SUMPS WIDTH ft DISTANCE TO NEAREST WELL ❑ DISPOSAL PONDS WIDTH ft ft DISTANCE TO NEAREST WELL ❑ SEEPAGE PITS NUMBER ft DISTANCE TO NEAREST WELL CAPACITY CAPACITY ft FOUNDATION _ ❑ PKG TX PLANT # OF LINES gal # OF COMPARTMENTS gal # OF COMPARTMENTS ft PROPERTY LINE ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) LENGTH OF LINES _ ft PROPERTY LINE DEPTH ft PROPERTY LINE DEPTH ft PROPERTY LINE DEPTH ft PROPERTY LINE DEPTH ft PROPERTY LINE DEPTH ft PROPERTY LINE 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. MINIMU HO ADV ICE REQUIRED FOR INSPECTIONS - PLEASE CALL 209) 953-7697 SIGNED TITLE 4fegN�-'7-0 DATE DEPARTMENT USE ONLY Application Accepted By "`� Date Z Z2 Area 3 Lro Employee ID# A. S" — Final Inspection By r1_VatL(.S(.V�� L� Date 0V1a1/2Z= ❑ SPECIAL PERMIT -Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS�I" %C40-11 1-7o o� ft PE Code ft FOUNDATION Check#/ Cash LENGTH Date Permit/ Service Request # ft Permit ID# ft FOUNDATION LENGTH L'R ;f ft ft FOUNDATION LENGTH ft ft FOUNDATION LENGTH ft ft FOUNDATION WIDTH ft ft FOUNDATION LENGTH OF LINES _ ft PROPERTY LINE DEPTH ft PROPERTY LINE DEPTH ft PROPERTY LINE DEPTH ft PROPERTY LINE DEPTH ft PROPERTY LINE DEPTH ft PROPERTY LINE 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. MINIMU HO ADV ICE REQUIRED FOR INSPECTIONS - PLEASE CALL 209) 953-7697 SIGNED TITLE 4fegN�-'7-0 DATE DEPARTMENT USE ONLY Application Accepted By "`� Date Z Z2 Area 3 Lro Employee ID# A. S" — Final Inspection By r1_VatL(.S(.V�� L� Date 0V1a1/2Z= ❑ SPECIAL PERMIT -Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS�I" %C40-11 1-7o o� ft PE Code Sc INFO Received B Check#/ Cash Amount Remitted Date Permit/ Service Request # Invoice # Permit ID# V2 Z'/ 07s ��2 L'R ;f Z 0 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4114/18 w �y b d A y K1