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P, , '1111! ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE-STOCKTON CA95205-(209)468.3420 NON-REFUNDABLE PERMIT CALL (209) 953-7697 FOR INSPEC77ONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS -1 ---> `f J C u � IJ= - CITY1ZIP -It-ft I- 11116. jI GPARCEL $IZCROSS STREET _N�13L OWNER NAME elCi 7, -Lr PHONE OWNER ADDRESS / ,�,`✓�(y� CITYISTATE01' / CONTRACTOR l i'L ( '(LfC� I Z-) C' -� C ,/�PHONE CONTRACTOR ADDRESS ! L+ `"/ �/� /•�'�/ CITYISTATE171P `� C, -�/ r•/ C��l/ LICENSE J _42 C-36 OTHER NUMBER / E%PIRAnON DATE - �I WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLAnoN ' REPaR1A7TION ENGINEER DESIGNED IALTERNATIVE REPLACEMENT "VICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: P RESIDENCE COMMERCIAL OTHER NUMBER OF LNING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPEIMFG/ �� •1 CAPACITY gal # OF COMPARTMENTS ❑ GREASE TRAP TYPEIMFG CAPACITY gal # OF COMPARTMENTS DISTANCE TO NEAREST: WELL It FOUNDATION ft PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) 1 HEREBY CERTIFY THAT 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 �/ �t<C �l�-•�/ TITLE /9.-I/-o1h DATE NT 2022 COUNTY ENTAL IRTMENT PARTME T7 SE ONLY Application Accepted BY"Z Date__IV `-� ZZ Area Employee 1 r?t Final Inspection By Date r SPECIAL PERMIT -Approved by Character of Soil to Depth of 3 PitlSump Soil Character: COMMENTS:T,>, �Z,k c./-PtA PE LEACH LINES LEACHING CHAMBERS III OF LINES Permltl LENGTHOFLNEs 101 ft INFO Cash Remitted DISTANCE TO NEAREST L C WELL ft FOUNDATION 1� ft PROPERTY LINE �O / ft ❑ FILTER BED WIDTH R 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 R DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ DISPOSAL PONDS Worm ft LENGTH It DEPTH ft DISTANCE TO AREST WELL R R PROPERTY LINE ft �( SEEPAGE PITS NUMBER /FOUNDATION W.3 [Q ft DEPTH S ft /\ DISTANCE TO 4EARrST WELL Lyhh ft FOUNDATION _A0 "' ft PROPERTY LINE 5 ft 1 HEREBY CERTIFY THAT 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 �/ �t<C �l�-•�/ TITLE /9.-I/-o1h DATE NT 2022 COUNTY ENTAL IRTMENT PARTME T7 SE ONLY Application Accepted BY"Z Date__IV `-� ZZ Area Employee 1 r?t Final Inspection By Date r SPECIAL PERMIT -Approved by Character of Soil to Depth of 3 PitlSump Soil Character: COMMENTS:T,>, �Z,k c./-PtA PE SC Received Check#! Amount Permltl Code INFO Cash Remitted Date Invoice # Permit IDN Service Request # 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18