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� a-7 70 I I ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 4683420 IVON-FIEFUNUABLE MEH77I1MIT �+J- I GALL ZU`J JJJ-/0J/ FOR INSPECTIONS Q tXPIHF=S I TEAR FROM DATE ISSUED JOB ADDRESS 22 1, Z -Z-6 7'1 . Z+305 5 1 FAC7> Ql� CITY21P IZ I Pd � IS' CROSS STREET W I PO hJ iz-� APN 2,24P -130 Z� i•,0 / Z�� PARCEL SIZE ) OWNER NAME `�"� I L EIy N K'1! I L p PHONE �'9 9A- OWNER ADDRESS 228445. •FREDERICK CITY/STATE/ZIP ILIPP&J C -A 793(e(o CONTRACTOR LIVE Q N IC GCp EN V I ROIV %% ENTAL PHONE 3409 -03-1 •' CONTRACTOR ADDRESS AFD )dr�t,K" 5 I CITY/STATE/ZIP Laub( I CA LICENSE iJGCA2 0,-C-36 OTHER LE� —NUMBER ZIi1 EXPIRATION DATE T -3o- 7-,4 WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ LEACH LINES PERC TEST #____I_ BUILDING PERMIT # # OF LINES LAND USE APPLICATION # ` � a TYPE OF WORK: _. NEW INSTALLATION ,., REPAWADDITION I.. ENGINEER DESIGNED/ALTERNATIVE ft FOUNDATION .... REPLACEMENT _.j OUT -OF -SERVICE SEPTIC SYSTEM 1 ] DESTRUCTION INSTALLATION WILL SERVE: _ RESIDENCE LI COMMERCIAL L' OTHER as 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 DISTANCE TO NEAREST DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) ❑ LEACH LINES LEACHING CHAMBERS # OF LINES LENGTH OF LINES ft Code DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ FILTER BED WIDTH ft LENGTH 00ol ft DEPTH It as 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 ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION 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. MINIMUM 487HOUR AD KaW NOTICE E IRED FOR INSPECTIONSS- PLEASE ALL 2 -7 SIGNED TITLE 0J- M ✓I'i Cl -X • DATE If' 4 ` 22— a ,•A ,moo, ,� 'DESIGNATED REMAINDER' I ,v+"• 9wi� u� s UG 18 2022 """"""` '",•, i PARCEL -1- ONMENTAL HEALTH PARCEL '3- _ •PERMIUSERVICES am wars xn Z_A_ __,. T -Il .aR Iti PgGgG 7;-Y w RI AUG 18 2022 SJAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT DEPARTMENT U E ONLY i Application Accepted -- Date Areal � C% C% Employee ID# (7 Final Inspection By Date C '�reSPE IAL PERMIT -Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character COMMENTS Pe✓rn+} YII7nnber inwr./ 4fe< h:F;ne trr�Yl.<�e r✓er� rnnn 1'S-') 1 1=. Lvcke r1rj. PE SC Received Check#/ Amount ate Permit/ Invoice # Permit ID# Code INFO Ca h Remitted Service Request# gaua liL 5P, po 04738 00ol as •Y 42-01 4/14/18 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT