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I ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE -STOCKTON CA 95205 -(209) 468-3420 NON-KEFUNDABLE PERMIT GALL ZU9 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUEI /, JOB ADDRESS s -S -y ?Z (w'x �c� Date I CITY/ZIP �)y�C�fa34r.. DISTANCE TO NEAREST CROSS STREET t APN o q 3 D 3 �S �I PARCEL SIZE 0?' FILTER BED WIDTH ft LENGTH 10% OWNER NAME�X �p� C PHONEO� OWNER ADDRESS S%j{yJe FOUNDATION ft PROPERTY LINE CITY/STATE/ZIP ❑ CONTRACTORO©E )) �j-SUz7 ft DEPTH ft DISTANCE TO NEAREST WELL ft CONTRACTOR ADDRESS �/ %f o TOUdC/GCL�► ft �%%�i,�� %�iG CITY/STATE/ZIP `]✓�GY:r�/>y G WIDTH LICENSE ❑-42 ❑I :C-36 OTHER ft DEPTH NUMBERSYOy� EXPIRATION DATE WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION ❑ PERC TEST # BUILDING PERMIT # TYPE OF WORK: D NEW INSTALLATION REPAIR/AD Coordinates X LAND USE APPLICATION #_ )N C ENGINEER DE I I REPLACEMENT i ' OUT -0F -SERVICE SEPTIC SYSTEM [ 1 DESTRUCTION Y GNED/ALTERNATIVE INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL per ) ❑ OTHER NUMBER OF LIVING UNITS: I NUMBER OF BEDROOMS: PL1 NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPE/MFG /shi 5 CAPACITY ❑ GREASE TRAP TYPE/MFG 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 QL LEACH LINES -! LEACHING CHAMBERS # OF LINES �_ LENGTH OF LINES LLO ft Date I Permit/ Service Request # DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE /QO ft ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL It 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 a1 WIDTH V ft DEPTH ft DISTANCE TO NEAREST WELL4&V' jA- ft FOUNDATION liar 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. DATE DEPARTMENT S ONLY /� Application Accepted B �'�G.z- Date /�� Area 1 qe? Employee ID# Final Inspection By (7 Date 7 ❑ SPECIAL PERMIT -Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS (%,nC�P,tP.YYA"Iv� � Pr :IT 10 �fc�6,/,? 1 / r iol r&my, iy; PE Code Sc INFO Received By Check#/ Cash Amount Remitted Date I Permit/ Service Request # Invoice # Permit ID# tldlz) its31� 42-01Hao(15 �� D _�p ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18