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A * i ` 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 G /) 1/I ¢CITY/ZIP :5'6"'k /K) (' CROSS STREET { �/QAN/Yllt� 1f. AP C `' 4 VQ1 O PARCEL SIZE �. ,? OWNER NAME L.)nlyi � j/�irIV�Y✓i PHONE 705- &;Z%/ OWNER ADDRESS/ - �lCw�`M'e CITY/STATE/ZIP G CONTRACTOR G�N�enL f�./��i� PHONE 3615, 'r/6Z7 CONTRACTOR ADDRESS 37 �� ThllJ /G J/�/L_ CITY/STATE/ZIP LICENSE ❑A-42 ❑ _ C-36 OTHER NUMBER L�J�Q�� tXPIRATION DATE 0!y/Z3 WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # TYPE OF WORK: I NEW INSTALLATION REPAIR/ADDITION I 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: 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. i SIGNED ''�d / TITLE Chi 7 /L i:�/,� DATE 7 //�r %j DEPARTMENT USE ONLY Application Accepted By �- v Date -7114-22 a2 Area Employee ID# {fit ►t 6� Final Inspection By Date I b. TIl, ❑ SPECIAL PERMIT -Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS 1�Fr _ uprklrrmin-eci, F_cisfI»d lines -ko eeillefln ,n use, PE Code SC INFO Received By Ch / ash Amount Remitted Date I ❑ SEPTIC TANK TYPE/MFG 1 S// Malo IIS, CAPACITY gal # OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG o 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) Xf__JLEACH LINES LEACHING CHAMBERS # OF LINES LENGTH OF LINES 5"S ft DISTANCE TO NEAREST WELL Ally ft FOUNDATION ft PROPERTY LINE _ S 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 I WIDTH ft DEPTH ft ft DISTANCE DISTANCE TO NEAREST WELL ft FOUNDATION S C' f ft PROPERTY LINE 6�� 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. i SIGNED ''�d / TITLE Chi 7 /L i:�/,� DATE 7 //�r %j DEPARTMENT USE ONLY Application Accepted By �- v Date -7114-22 a2 Area Employee ID# {fit ►t 6� Final Inspection By Date I b. TIl, ❑ SPECIAL PERMIT -Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS 1�Fr _ uprklrrmin-eci, F_cisfI»d lines -ko eeillefln ,n use, PE Code SC INFO Received By Ch / ash Amount Remitted Date I Permit/ Service Request # Invoice # Permit ID# Malo IIS, 31a (Ila o 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18 T d 0