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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-KEFUND�ABBLLE PERMIT UALLLU,9Ybd-10YI FOR INSPECTIONS tXPIRES 1 YEAR FROM DATE ISSUEI JOB ADDRESS �7 `(� �� � � 1� CITY/ZIP ell ft FOUNDATIONft PROPERTY LINE ft ❑ FILTER BED o8?� �a 33 ft LENGTH 0• CROSS STREET 1S�G.«- APN PARCEL SIZE ft FOUNDATION ft PROPERTY LINE ft ^GI OWNER NAME C 'c -cc's PHONE, n2nq— q7!) _,;b _Cy DISTANCE TO NEAREST OWNER ADDRESS ��a/{�1�(/ CITY/STATE/ZIP ❑ SUMPS WIDTH I��-C I r Gf� !I q(' DISTANCE TO NEAREST CONTRACTOR Y V L k ,3-� � PHONE ❑ DISPOSAL PONDS WIDTH CONTRACTOR ADDRESS IQ ay CITY/STATE/ZIP M00j_cCA I ell !76 J. Xe LICENSE El -C-42 [111C-36 OTHERS NUMBER EXPIRATION DATEo / NUMBER WIDTH WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT # unc=2LAND USE APPLICATION # TYPE OF WORK: I. NEW INSTALLATION g,, REPAIR/ADDITION IGINEER DESIGNED /ALTERNATIVE REPLACEMENT OUT -0F -SERVICE SEPTIC SYSTEM i, DESTRUCTION IC INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL 3 C* ,S'1_M4 j El OTHER NUMBER OF LIVING UNITS: ' NUMBER OF BEDROOMS: ( a a Oded NUMBER OF EMPLOYEES: SEPTIC TANK TYPE/MFG / * L CAPACITY ^�Opp gal # OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS t DISTANCE TO NEAREST: WELL (j I ft FOUNDATION d ft PROPERTY LINE -7S ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) 0 -'LEACH LINES L LEACHING CHAMBERS # OF LINESQpr t1 LENGTH OF LINES JrS # ft ec ash DISTANCE TO NEAREST WELL ft FOUNDATIONft 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 DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft 'SEEPAGE PITS NUMBER WIDTH 3�'I ft DEPTH a -J r ft DISTANCE TO NEAREST WELL Sn) ft FOUNDATION I ft PROPERTY LINE �� ft 1 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. TITLE (/p I (`aGrf at (- DEPARTMENT USE ONLY c Application Accepted By /_ Date Area Employee ID# F1'4. 1 V Final Inspection By Date ❑ SPECIAL PERMIT -Approved by Character of Soil to Depth A Ft: Pit/Sump Soil Character: COMMENTS R -,.yo ,r)d l PoAS 4o hou_3e_ Non yen. Ir_ Tiler ff- PE Code SC INFO ReceivedCh By ec ash Amount Remitted Date Permit/ Service Request # Invoice # Permit ID# ya1v 15 �3ao � � .� 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18 Mm v v rn