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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 TYPE/MFG ZUY Y53-/tiYl FOR INSPECTIONS 1 YEAR FROM DATE ISSUEI JOB ADDRESS L T j� / `o 1 of ��) +ptXPII�RES �`C:ALL / �e� � CITpY/,,ZIIP dA1(Cr-Il_ C4, 7s3bI CROSS STREET / N IZ�. APN 2_03 - 2-9 V ` Z Q PARCEL SIZE 17- qS OWNER NAME ` (�^kAp 'T c) ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) I l 11 �i L P i� Iri e+k PHONE OWNER ADDRESS I pSIa (��VC� ^y��^ O. + / IZA , CITY/STATE/ZIP ACRS (� ry C -1577-Z_�/ CONTRACTOR ��(%r-;6,�11 ]�0-nt }}��J l��'`L% kae_' PHONE �� (��5 59,5 7 V /Z CONTRACTOR ADDRESS AJ 6OX f `I S7 [.r s 4 -lo 1 CITY/STATE/ZIP 5 64 97 Z q LICENSE ❑[1C-42❑'_IC-36 OTHER NUMBER EXPIRATIONDATE (� -1100` z'3 WATER TABLE DEPTH: OC' 10 C. = it GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT # L ] D ;`i SSS LAND USE APPLICATION # TYPE OF WORK: V NEW INSTALLATION I REPAIR/ADDITION ENGINEER DESIGNED /ALTERNATIVE REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: VRESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: I NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: Ua SEPTIC TANK TYPE/MFG CAPACITY 12 © gal # OF COMPARTMENTS L ❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS WELL l ft /�} DISTANCE TO NEAREST: WELL z -o V ` p- I ft FOUNDATION n [ 1 ft PROPERTY LINE k c>o -r ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) 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. DEPARTMENT ILSE ONLY Application Accepte Date % Area l / Employee ID# /T Final Inspection By. Date O �/' ❑ SPECIAL PERMIT -Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: �C MMENTS ��J /��/ �zE/Gf2l �c/n� 2 614 ,� as - �1 ryIP��CiIPaC/� oe.r ml.} tJ 3-SS�J�•c11 I�h�_< 12(� 3" ya f,12ias. C)rtri"I( )Dr- pf0Jncl,- UPS I< PE I SC Received 6Lhet`R#/ I Amount Date Permit/ Invoice # Permit ID# Code INFO Bp Cash Remitted I Service Request # '2_r 111-7 Is �`� I I 2qZI 5141( in"" 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18 LEACH LINES 1 LEACHING CHAMBERS # of LINES % LENGTH OF LINES 'L Cff ft DISTANCE TO NEAREST WELL l ft FOUNDATION Z ft PROPERTY LINE 0 1 ft ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft (3 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 X3 WIDTH��+\ ft �` DEPTH Z ' ft DISTANCE TO NEAREST � WELL 7 ft FOUNDATION Z 1 ft PROPERTY LINE i aU t- 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. DEPARTMENT ILSE ONLY Application Accepte Date % Area l / Employee ID# /T Final Inspection By. Date O �/' ❑ SPECIAL PERMIT -Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: �C MMENTS ��J /��/ �zE/Gf2l �c/n� 2 614 ,� as - �1 ryIP��CiIPaC/� oe.r ml.} tJ 3-SS�J�•c11 I�h�_< 12(� 3" ya f,12ias. C)rtri"I( )Dr- pf0Jncl,- UPS I< PE I SC Received 6Lhet`R#/ I Amount Date Permit/ Invoice # Permit ID# Code INFO Bp Cash Remitted I Service Request # '2_r 111-7 Is �`� I I 2qZI 5141( in"" 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18