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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 NUN-MLII-UNUAbLt VLHMI I L ALL (ZU`J/ `JO3-/0y/ FOR INSPECTIONS tXPIREGS l YEAR FROM DATE ISSUE JOB ADDRESS I� X093 E. ORE -1 L CT. . CITY/ZIP P -kr pw �+N 9S)rtq& CROSS STREET 6-AJ2 APN 2-4E--C190-3e I_ PARCEL SIZE Z • 110 � • ,,//rr,,�rLAJ�� �E} OWNER NAME rVr�C i3ER-rsco REPLACEMENT PHONE (&6S- 5'7-34 Cho twtERh1.1> ButL(>69-S _ OTHER _ OWNER ADDRESS �T�n,�. r . on ii N C� S TE. B CITY/STATE/ZIP (Lt Pa AJ CA, c15 3(0(o CONTRACTOR L -►JE DAK &L0FNVNZ0rVMF-r-, CAPACITY AL- PHONE 3&4? -0371s CONTRACTOR ADDRESS �fy-1 Pj . 0 PC/K $7-1- -CITY/STATE/ZIP q L -.OD ( . C- 2''4 LICENSE L'.;C-42 11 C-36 OTHER C v NUMBER Z I - ( EXPIRATION DATE 4-30-2-4 WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y D ❑ LEACH LINES LEACHING CHAMI DISTANCE TO NEAREST ❑ FILTER BED WIDTH DISTANCE TO NEAREST ❑ MOUNDED WIDTH DISTANCE TO NEAREST ❑ SUMPS WIDTH DISTANCE TO NEAREST ❑ DISPOSAL PONDS WIDTH DISTANCE TO NEAREST ❑ SEEPAGE PITS NUMBER DISTANCE To NEAREST S PERC TEST # I FBUILDING PERMIT # WELL LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION _. ENGINEER DESIGNED/ALTERNATIVE WELL Anda REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: RESIDENCE COMMERCIAL _ OTHER ft NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPE/MFG CAPACITY gal # OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS ft FOUNDATION _ft DEPTH DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE It ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) ❑ LEACH LINES LEACHING CHAMI DISTANCE TO NEAREST ❑ FILTER BED WIDTH DISTANCE TO NEAREST ❑ MOUNDED WIDTH DISTANCE TO NEAREST ❑ SUMPS WIDTH DISTANCE TO NEAREST ❑ DISPOSAL PONDS WIDTH DISTANCE TO NEAREST ❑ SEEPAGE PITS NUMBER DISTANCE To NEAREST S ft # OF LINES WELL ft ft FOUNDATION_ ft LENGTH Remitted WELL Anda ft FOUNDATION ft LENGTH ECEIVED WELL ft ft FOUNDATION ft LENGTH t+ Ur 18 20"22 WELL It ft FOUNDATION ft LENGTH InAQUIN COUNTY WELL ftE ft FOUNDATION WELL ft FOUNDATION LENGTH OF LINES ft Check#/ ft PROPERTY LINE ft Code ft DEPTH "PAYMENT Remitted ft PROPERTY LINE Anda S33 191 ft DEPTH n ECEIVED ft PROPERTY LINE ft ft DEPTH ft t+ Ur 18 20"22 ft PROPERTY LINE It 4J ft DEPTH t InAQUIN COUNTY ft PROPERTY LINE ftE VIRONMENTAL _ft DEPTH LTH DEPARTMENT 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. r1 r TITLE I0X0J. M 64 - DEPARTMENRUSIE ONLY Application Acoepte By Date &442-:2Area KA Employee ID# Final Inspection By Date 'LOZ'1-j SPECIAL PERMIT -Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS R1 i Bell Cr'P, S RoOY1173 8 PE SC Received Check#/ Amount ate Permit/ Invoice # Permit ID# Code INFO B Cash Remitted Servic Re u st # Anda S33 191 q,4p a 1416 0001 40s- 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18 ED ENTAL HEALTH