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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 PERMIT CALL (209) 953-769/ FOR CAPIKtb I T LAK P KUM LJA I G IJZUCU JOB ADDRESS CROSS STREET �.. OWNER NAME ✓1 C""{L.L-GL �1 L I yp IV fR GLc.�. It L 1(6-- CITY/ZIP {{ U ..-/C0n.__ �? PARCEL SIZE % �y ( PHONE `�'v1 "- 6 / q CJ .� APN I CSL ��.G BUILDING PERMIT # 2 (/ / L/ % l`, t �y,% GL OWNER ADDRESS CONTRACTOR =//''L/p C.LVI�Lt CITY/STATE/ZIP ,/ 0 PHONE 9 f ENGINEER DESIGNED /ALTERNATIVE �''y " — ��J Y1a ! i C- �j V (LLL�/y 11`Qe CONTRACTOR ADDRESS QQS �® E.J ® X,�O R CITY/STATE/ZtP IGD71 0, { 4-&-1� , CAG { s-6 LICENSE C-42 i /� C-36 OTHER 'A NUMBER r_I I-esEXPIRATION DATE- WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y ate Permitt Invoice # rvice Re ues PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # _ TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION 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: ❑ SEPTIC TANK TYPE/MFG CAPACITY gal # OF COMPARTMENTS__ ❑ GREASE TRAP TYPE/MFG CAPACITYgal # OF COMPARTMEN-S DISTANCE TO NEAREST: WELL It FOUNDATION It 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 � - It 1. DISTANCE TO NEAREST WELL ZUCI ft FOUNDATION ZCJ1 ft PROPERTYLINE f UGC r' ft ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL _ It FOUNDATION It PROPERTY LINE _ it ❑ MOUNDED WIDTH _ It LENGTH _ it DEPTH ft DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE it ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL It 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 44 Z " ft DEPTH Z 5- It DISTANCE TO NEAREST WELL-5-C,C' —ft FOUNDATION 20t JJ ft PROPERTY LINE LCCt ft 1 HEREBY CERTIFY THAT 1 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 Application Accepted By Final Inspection By Character of Soil to Depth of 3 COMMENTS DEPARTMEN U E NLY 1 Date E" Area Date `i 3 -2v" SPECIAL PERMIT Pit/Sump Soil Character: DATE 7— L-- 70(7Z TY NT Employee ID#—� f Z Approved by PE Code Z G SC Received Check* INFO ash iS Amount Remitted iL ate Permitt Invoice # rvice Re ues Permit ID# 42-01 -�t 1 It ✓IC/ L./ 4/14/18 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT