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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 NON-KEFUNDABLE PERMIT (:ALL /LUY) .90d-/Oy/ FOR INSPECTIONS tXPIRES "I YEAR FROM UATE ISSUE JOB ADDRESS A/ -% fI/ S f,ef CITY/ZIP CROSS STREET CA rre � APNN 090)300-7 PARCEL SIZE (. q � ]�y OWNER NAME &V i P.n �T Yi � -,ar AA h, ee4 —PHONE^ �7 �/9 OWNER ADDRESS �I/Z-Z`/`�3 �� i % CITY/STATE/ZIP /7%�4 L'•/�lj y�( �_yfl 7/ , CONTRACTOR y / e S (% PHONE ^� CONTRACTOR ADDRESS �D / / CITY/STATE/ZIP �l ' J_% l / L LICENSE V�C-42 [I !C-36 OTHER NUMBER 3e O/ EXPIRATION DATE WATER TABLE DEPTH: / ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT # 30O 3 1 SS LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION I REPAIR/ADDITION I I ENGINEER DESIGNED /ALTERNATIVE REPLACEMENT I OUT -0F -SERVICE SEPTIC SYSTEM I DESTRUCTION INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: 5 NUMBER OF EMPLOYEES: Ur SEPTIC TANK TYPE/MFG (3 GREASE TRAP TYPE/MFG lr LEACH LINES LEACHING CHAMBERS # OF LINES LENGTH OF LINES Sft - /!-� �r DISTANCE TO NEAREST WELL C ft FOUNDATION ft PROPERTY LINE J7 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 SUMPS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft Ll CAPACITY CAPACITY DISTANCE To NEAREST: WELL t FOUNDATION _ LIFT STATION SIZE L_4.TYPE OF PUMP 1 �IN�� ❑ PKG TX PLANT QL7�9 gal # OF COMPARTMENTS gal # OF COMPARTMENTS ft PROPERTY LINE ft ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) i�SEEPAGE PITS NUMBER WIDTH SC INFO Received By Chep as Amount Remitted Date Permit/ Service Request # Invoice # Permit ID# LID) 11 g *SBI 2 Z2 0 S DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEA EST WELL ft OUNDATION ft PROPERTY LINE ft 41211 L�c� ft DEPTH �•l, ft DISTANCE TO NEAREST WELL ft FOUNDATION 7e 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. Awl ill■\�■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ � r PE Code SC INFO Received By Chep as Amount Remitted Date Permit/ Service Request # Invoice # Permit ID# LID) 11 g *SBI 2 Z2 0 S 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18 T