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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-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUE[ JOB ADDRESS I I,;IjQI F L't 11L OCLV_ 9 IA CITY/ZIP ^L-.0.4 1 CROSS STREET /7 w y &p APN O PARCEL SIZE 1192 OWNER NAME f5�1k^ta p II c>Vye-5 PHONE OWNER ADDRESS I I I'D Lie- Ck.- - Q'x CITY/STATE/ZIP L,391 CA RSa,10 CONTRACTOR 0U-)nC1- PHONE Q.og ) 9 1 L --7S b10 CONTRACTOR ADDRESS CITY/STATE/ZIP LICENSE ❑ C-42 ❑ C-36 OTHER NUMBER EXPIRATION DATE WATER TABLE DEPTH: (S ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION Ne' REPAIR/ADDITION ENGINEER DESIGNED /ALTERNATIVE REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: V RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: 3 NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPE/MFG ❑ GREASE TRAP TYPE/MFG CAPACITY CAPACITY DISTANCE TO NEAREST: WELL ft FOUNDATION ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT gal # OF COMPARTMENTS gal # OF COMPARTMENTS ft PROPERTY LINE ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) ft 51' LEACH LINES LEACHING CHAMBERS # OF LINES_ LENGTH OF LINES SS r 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. MINIMUM 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 SIGNED TITLE DATE c5 -Q- ?2 - DEPARTMENT Z DEPARTMENT USE ONLY Application Accepted B �- Lem li Date � Area � C Employee ID# Final Inspection By, ��< Date ❑ SPECIAL PERMIT -Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS ()rlje+e-(w11YleCa . e✓ e x �s� i.�c (j>1es L? LC r1 C: n6AY E CA1.51 PE Code SC INFO DISTANCE TO NEAREST WELL S0 ft FOUNDATION �O ft PROPERTY LINE �G7 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 ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft �/ Oli SEEPAGE PITS NUMBER 3 WIDTH 3,b & ft DEPTH RSft DISTANCE TO NEAREST WELL 100 ft FOUNDATION co rr ft PROPERTY LINE JO 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. MINIMUM 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 SIGNED TITLE DATE c5 -Q- ?2 - DEPARTMENT Z DEPARTMENT USE ONLY Application Accepted B �- Lem li Date � Area � C Employee ID# Final Inspection By, ��< Date ❑ SPECIAL PERMIT -Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS ()rlje+e-(w11YleCa . e✓ e x �s� i.�c (j>1es L? LC r1 C: n6AY E CA1.51 PE Code SC INFO Received Check#/ Cash Amount Remitted Date Permit/ Service Request # Invoice # Permit ID# 931 D IS -Alt l5/-�- # 3aQ by 2 42-01 v Y J `� v [ l ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18 r