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r ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 NON-KEFUNDABLE PERMIT( (;ALL LU9 Yb3-/69/ FOR INSPECTIONS // tXPIRES 1 YEAR FROM DATE ISSUE JOB ADDRESS 6J (^ � ( lY l -t/ Z/ 1L2 CITY/ZIP h O 1 / L`J CROSS STREET APIN — :J -7o e)3 PARCEL SIZE _ OWNER NAME //� 11 � T-6 i7 L'�(%� / f/ I ` PHONE ❑ PERC TEST # Amount emitted OWNER ADDRESS ��" / i-vy �'^ CITY/STATE/ZIP TYPE OF WORK: CONTRACTOR `1,:52 �� PHONE SKOOV1507 lO �� %�� CAL �3/b% CONTRACTOR ADDRESS OUT -OF -SERVICE SEPTIC SYSTEM CITY/STATE/ZIP ,Oe A G / I > '/ LICENSE VC -42 ❑ C-36 OTHER NUMBER �V( 36-6_ EXPIRATION DATE -3 v2 / WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # Amount emitted Date BUILDING PERMIT # LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED /ALTERNATIVE SKOOV1507 REPLACEMEN OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: I NUMBER OF BEDROOMS: .Z, NUMBER OF EMPLOYEES: SEPTIC TANK J TYPE/MFG / / (J s A 1 L� J^ CAPACITY / � J L/ 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 LEACHING CHAMBERS # OF LINES �_ LENGTH OF LINES "t� ft DISTANCE TO NEAREST WELLD� ft FOUNDATION ft 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 —/ l�( SUMPS WIDTH 'l ft LENGTH 7-F-' '(i 0% ft DEPTH 101 ft r DISTANCE TO NEAREST WELL 119-0 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 ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION 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. SIGNED Z =9.4 A474 TITLE DATE DEPARTMENT USE ONLY 9 /` Application Accepted By Date Area (� Employee ID# c� Final Inspection By Date �- Ll SPECIAL PERMIT -Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS <77- We.TI / fAoW 1YlsiMhl' -Co 2 - 4-9,I L L L3"1 -6'A --1�I. , I d4v� PE Code SC INFO Received By eck��#n! ro%q Amount emitted Date Permit/ Service Requepj# Invoice # Permit ID# SKOOV1507 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18 r