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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1666 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 NUN-MEt-UNUAbLE t'LHpp..., MIT GALL ZU'J y,)J-/6'J/ FOR INSPECTIONS LXPIRES 1 YEAR FROM DATE ISSUEI JOB ADDRESS 2-3 , 0 S 'tyST/ty 12-6 . -CITY/ZIP F-) PCN IN 3(4 CROSS STREET Vit ST 9-1 PL',IJ APN ZZ�- 130" 3 PARCEL SIZE 2.1 kc OWNER NAME S j"j -A 117- t 71 J L 12 0 PHONE t 9 ys) 9 £�iSl q OWNER ADDRESS S& IM C CITY/STATE/ZIP -1 CONTRACTOR L -W t 0,kile- PHONE C 2C`I \ J 3to1G, -Uj I ! CONTRACTOR ADDRESS 4C-1-1 W - /�O A {L S t • CITY/STATE/ZIP LICENSE L.'...',C-42 El: !:C-36 OTHER ce& NUMBER �1 EXPIRATION DATE 30 - 2 - WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y ]( PERC TEST # I BUILDING PERMIT # LAND USE APPLICATION # TYPE OF WORK: .. NEW INSTALLATION .. REPAIR/ADDITION ._, ENGINEER DESIGNED/ALTERNATIVE WIDTH _. REPLACEMENT _. OUT -OF -SERVICE SEPTIC SYSTEM .... DESTRUCTION INSTALLATION WILL SERVE: a RESIDENCE COMMERCIAL C OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPE/MFG CAPACITY gal # OF COMPARTMENTS ❑ 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) ❑ LEACH LINES I LEACHING CHAMBERS Check#/ # OF LINES Permit/ DISTANCE TO NEAREST WELL Cash ft FOUNDATION_ ❑ FILTER BED WIDTH ft LENGTH L 11 ti DISTANCE TO NEAREST WELL ft FOUNDATION_ ❑ MOUNDED WIDTH ft LENGTH DISTANCE TO NEAREST WELL ft FOUNDATION ❑ SUMPS WIDTH ft LENGTH DISTANCE TO NEAREST WELL ft FOUNDATION ❑ DISPOSAL PONDS WIDTH ft LENGTH DISTANCE TO NEAREST WELL ft FOUNDATION ❑ SEEPAGE PITS NUMBER WIDTH DISTANCE TO NEAREST WELL ft FOUNDATION LENGTH OF LINES ft ft PROPERTY LINE ft ft DEPTH ft ft PROPERTY LINE ft It DEPTH ft ft PROPERTY LINE ft ft DEPTH ft ft PROPERTY LINE ft ft DEPTH ft ft PROPERTY LINE ft _ft DEPTH ft 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. MINIMUMMINIMUMAS jjQUR AiRZWCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL 953-7697 S SIGNED TITLE r "-t Vill G'2 DATE ~I - -1 - 22- DEPARTMENTUS ONLY n ` Application Accepted B l 1, Date 1/ Area1Iq Employee ID# Ny Final Inspection By Date -L ECTAL PERMIT - Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: CQMMENTS 1.1,,Og FPS' 6f pp rm J f -f-;" 323d'7 P , fd, n (-r1- I e A C n / YV A4 7-rqA) f-) d 1'--1 r L,c r PE SC Received Check#/ Amount Permit/ Code INFO ELY Cash Remitted ate Invoice# PermitID# i Service FlIggluest # Lpaa sa3 s L 11 ti of *as 42-01_ ,("'! ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18 i (/''W,'l` LENT ;IVSD 1 2022 N COUNTY MENTAL DARTMENT