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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN iOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 NON-REFUNDABLE PERMIT CALL ZU9 953-7697 FOR INSPECTIONS tXPIRES 9 YEAR FROM DATE ISSUEI �� JOB ADDRESS zyz 'cKli /i 'c v 1 Ii ` CITY/ZIP gal # OF COMPARTMENTS �/ �i/ CROSS STREET l� r�1 DISTANCE TO NEAREST: WELL APN�7 %7 7 Ci PARCEL SIZE / OWNER NAME C- SIZE TYPE OF PUMP ❑ PKG TX PLANT PHONE Z4"71- 663"'lk' 7 FOUNDATION /D ft PROPERTY LINE ft ❑ FILTER BED OWNER ADDRESS —1�0' yy) e ft CITY/STATE/ZIP ft DEPTH CONTRACTORS_r1//.��C= PHONE DISTANCE TO NEAREST WELL CONTRACTOR ADDRESS ->;72Z// ��^� y� /'%�� /90f CITY/STATEIZIP ft ❑ MOUNDED WIDTH ft LICENSE ❑ ❑I 'C-36 OTHER NUMBER `I�S�%�i t�� EXPIRATION DATEO WATER TABLE DEPTH: _ 14D ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # I BUILDING PERMIT # LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLATIONrr REPAIR/ADDITION ENGINEER DESIGNED /ALTERN TIVE •� REPLACEMENT Tw/C fIF'�U OUT -0F -SERVICE SEPTIC SYSTEM ;K DESTRUCTION 5��p `1 ni �'� l( INSTALLATION WILL SERVE: I$ RESIDENCE ❑ COMMERCIAL❑ OTHER NUMBER OF LIVING UNITS: I NUMBER OF BEDROOMS: a NUMBER OF EMPLOYEES: SEPTIC TANK TYPE/MFG /�' L CAPACITY �Z�'L gal # OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS V-�LEACHING CHAMBERS DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYM WELL_,9-2Ya'o��ft FOUNDATION /D ft PROPERTY LINE ft ❑ FILTER BED 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 VR I1r17r1--V I IWIVO - rLC/YJC V44LL I LVJ/ .7013-/ VVI TITLE- DATE Z/i�z7 7 DEPARTMENT U E ONLY Application Accepted By �— /�� Date a Area a Employee ID#__ Final Inspection By Date ❑ SPECIAL PERMIT - Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS --r;er .-If . i.m e:+efA4Iyit Sebt,C 4v4ywrn Fzw11)ueP f' x,tfu'»� IV, -'Ch hor-, PE Code SC INFO Received hec By Cash G o kF UC-- L3"7�- �— -- 6 6. LEACH LINES V-�LEACHING CHAMBERS b 31� # OF LINES I LENGTH OF LINES Z ft DISTANCE TO NEAREST WELL_,9-2Ya'o��ft FOUNDATION /D 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 ft1 FOUNDATION ft PROPERTY LINE ft ja sumps WIDTH Z ft LENGTH / Z ft DEPTH r0 ft DISTANCE TO NEAREST WELL /e10" - ft FOUNDATION 10 ft PROPERTY LINE 3G7 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 VR I1r17r1--V I IWIVO - rLC/YJC V44LL I LVJ/ .7013-/ VVI TITLE- DATE Z/i�z7 7 DEPARTMENT U E ONLY Application Accepted By �— /�� Date a Area a Employee ID#__ Final Inspection By Date ❑ SPECIAL PERMIT - Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS --r;er .-If . i.m e:+efA4Iyit Sebt,C 4v4ywrn Fzw11)ueP f' x,tfu'»� IV, -'Ch hor-, PE Code SC INFO Received hec By Cash Amount Remitted Dae Permit/ Service Request # Invoice # Permit ID# (O rIs' b 31� fI 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18