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L -i ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 NON-REFUNDA U-329 BLE PERMIT GALL ZO'J bF0J-f0.Vf FOR INSPECTIONS tXPIRE5 I YEAH FROM DATE 155UEI JOB ADDRESS 3`3 2 9 S • 1311=D r p • CITY/ZIP -ni� ) 53c T CROSS STREET DltI 9' Rf% W" F L ?--9 y APN 2 S 3 -3L, Cl - c `4 PARCEL SIZE � + � `f At OWNER NAME ' 11Nti -'N CJ rtE d�'IeU 1zo6V1+ ge+nu+CJ/ ? b'1 PHbONErlGl (q70 3G -S - 9514 OWNER ADDRESS S ^VV\ t_ CITY/STATE/ZIP CONTRACTOR "VE E it/ {SIL AL- PHONE J V' - 0 ') > y CONTRACTOR ADDRESS `t 1 �' C'+�k' �� ^f CITY/STATE/ZIP E ( C LICENSE L';.'.0-42 ❑UC -36 OTHER CEL NUMBER Z (� ( EXPIRATION DATE - -3& z4 WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y X PERC TEST # I BUILDING PERMIT # LAND USE APPLICATION # TYPE OF WORK: I NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE I s I REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM i DESTRUCTION INSTALLATION WILL SERVE: _1 RESIDENCE ❑ COMMERCIAL - OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: MOUNDED NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPE/MFG CAPACITY gal # OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS ft DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP O PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) ❑ LEACH LINES LEACHING CHAMBERS ❑ ❑ Ll # OF LINES ION ft It ft ft LENGTH OF LINES ft ft PROPERTY LINE ft DEPTH ft ft PROPERTY LINE ft DEPTH ft ft PROPERTY LINE It DEPTH ft ft PROPERTY LINE ft DEPTH ft It PROPERTY LINE 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. 7� DEPARTMENT USEON Application Accepted By Z-i'�- �' Date Area C Employee ID# k� Final Inspection By Date ❑ SPECIAL PERMIT - Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS PE DISTANCE TO NEAREST WELL Permit/ Invoice # Permit ID# ft FOUNDAT FILTER BED WIDTH ft LENGTH I s I tid "17 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 ION ft It ft ft LENGTH OF LINES ft ft PROPERTY LINE ft DEPTH ft ft PROPERTY LINE ft DEPTH ft ft PROPERTY LINE It DEPTH ft ft PROPERTY LINE ft DEPTH ft It PROPERTY LINE 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. 7� DEPARTMENT USEON Application Accepted By Z-i'�- �' Date Area C Employee ID# k� Final Inspection By Date ❑ SPECIAL PERMIT - Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS PE SC Received Check#/ Amount D e Permit/ Invoice # Permit ID# Code INFO B Cash . Remitted Service Request # L� a sa I s I tid "17 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18 NT FED 2022 ,OUNTY NTAL ITMENT