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T 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 �5ya4 IIn n C --kA `CIfta A CITY/ZIP On ..¢ x="IL 17 -c- �`�e�,- ] CROSS STREET ( I ` rorr� I e APN 1970 700 PARCELSIZE OWNER NAME Sc^ck111r fC+►?VIQ1� %� Tlt. PHONE OWNER ADDRESS -(A Me SUMPS CITY/STATE/ZIP ft CONTRACTOR �I 1�1 14GGK 4. t C r PHONE DISPOSAL PONDS CONTRACTOR ADDRESS '�0 a 1 L) CITY/STATE/ZIP DISTANCE TO NEAREST LICENSE 111C-42 ❑ 11C-36 OTHER NUMBER EXPIRATION DATE ft WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # TYPE OF WORK: N W INSTALLATION REPAIR/ADDITION 1 1 ENGINEER DESK {/ REPLACEMENT OUT -0F -SERVICE SEPTIC SYSTEM X DESTRUCTION INSTALLATION WILL SERVE: U2EESIDENCE ❑ COMMERCIAL 11OTHER 7 NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: , J NUMBER OF EMPLOYEES: S.M.- . ❑ SEPTIC TANK TYPE/MFG ( 4f"' %*.r �lob CAPACITY ! b gal # OF COMPARTMENTS_ ❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS DISTANCE TO NEAREST: WELL__,1�10 I ft FOUNDATION ft PROPERTY LINE % I ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) D /ALTERNATIVE LEACH LINES I LEACHING CHAMBERS_ FOUNDATION DISTANCE TO NEAREST WELL FILTER BED WIDTH ft Permit ID# DISTANCE TO NEAREST WELL MOUNDED WIDTH ft DISTANCE TO NEAREST WELL SUMPS WIDTH ft LENGTH DISTANCE TO NEAREST WELL DISPOSAL PONDS WIDTH ft FOUNDATION DISTANCE TO NEAREST WELL SEEPAGE PITS NUMBER ft DISTANCE TO NEAREST WELL # OF LINES ft LENGTH OF LINES _ ft PROPERTY LINE DEPTH ft PROPERTY LINE DEPTH ft PROPERTY LINE DEPTH ft PROPERTY LINE DEPTH ft PROPERTY LINE DEPTH ft PROPERTY LINE 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 IIVOrCL, I /VIVO - r"1_C/10C IiMLL (LV: TITLE �-n 0� ('cL4C6 r DATE J DEPARTMENT US ONLY Application Accepted By L_� 1 Z__ Date d Area u Employee ID# 14 C? Final Inspection By Date 3O SPECIAL PERMIT -Approved by Character of Soil to Depth of 3 Ft: PiUS/u' mp Soil Character: COMMENTS LkidP-ftli otlet! Tile f ) 1 0A_ t7�1h` - S t. r- EAc% It PE Code ft FOUNDATION Chec LENGTH Date Permit/ Service Re uest # ft Permit ID# ft FOUNDATION LENGTH 3O0 ft ft FOUNDATION LENGTH ft ft FOUNDATION LENGTH ft ft FOUNDATION WIDTH ft FOUNDATION ft LENGTH OF LINES _ ft PROPERTY LINE DEPTH ft PROPERTY LINE DEPTH ft PROPERTY LINE DEPTH ft PROPERTY LINE DEPTH ft PROPERTY LINE DEPTH ft PROPERTY LINE 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 IIVOrCL, I /VIVO - r"1_C/10C IiMLL (LV: TITLE �-n 0� ('cL4C6 r DATE J DEPARTMENT US ONLY Application Accepted By L_� 1 Z__ Date d Area u Employee ID# 14 C? Final Inspection By Date 3O SPECIAL PERMIT -Approved by Character of Soil to Depth of 3 Ft: PiUS/u' mp Soil Character: COMMENTS LkidP-ftli otlet! Tile f ) 1 0A_ t7�1h` - S t. r- EAc% It PE Code SC INFO Received By Chec Amount Remitted Date Permit/ Service Re uest # Invoice # Permit ID# H,� oq 1 5 l 3O0 112D� 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18