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i U ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 NON-KEFUNDABLE PERMIT ` .InR GnnRFcc -3 // GALL (ZUy) 903-/6y/ FOR INSPECTIONS CITY/ZIP tXPIRES 1 YEAR FROM UATE ISSUE y '-FS-30 '2' CROSS STREET ,Gl:J IL/Y% T ��"i lLAPN / Z 5S c 2� b / �' PARCEL SIZE 1c, 6 OWNER NAME WLR /iJ J � S.� �%T S �-//tea L-- /.y C.%� PHONE OWNER ADDRESS A- d `SD L/ ] �fllj^ T� CITY/STATE/ZIP CONTRACTOR �J� \ 2 c�^� STS`-%%a�� PHONE CONTRACTOR ADDRESS Z �J/ C� /ST ��- CITY/STATE/ZIP LICENSE 111iC-42 11OC-36 OTHER NUMBER 804 EXPIRATION DATE ` ftr WATER TABLE DEPTH: 1k> Z v ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT # "fit .e LAND USE APPLICATION # io-1-20 S 00 TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION X ENGINEER DESIGNED /ALTERNATIVE I I REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: ❑ RESIDENCE II COMMERCIAL ❑ OTHER 5 �� NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: Sa eG YI w (� SEPTIC TANK +fe, TYPE/MFG J" - 1: e- 1< CAPACITY 7 50� gal # OF COMPARTMENTS El GREASETRAP Cr'l TYPE/MFG . CAPACITY gal # OF COMPARTMENTS 77 � i 0 DISTANCE TO NEAREST: WELL ,7 ft FOUNDATION V ft PROPERTY LINE 3'4/ ft �/ 04 LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) 3 LEACH LINES _ LEACHING CHAMBERS # OF LINES 2- LENGTH OF LINES !w ft DISTANCE TO NEAREST WELL S' ft FOUNDATION Z 2 O ft PROPERTY LINE _ Z43 b ft ❑ FILTER BED WIDTH _ ft LENGTH It 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 It LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH It DISTANCE TO NEAREST - WELL - It FOUNDATION ft PROPERTY LINE ft I HEREBY CERTIFY T E PRE D 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. M/ UM 48 U A VANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL 209 953-7697 SIGNED TITLE /�'E31�� DATE Zn DEPARTMENT,USE ONLY Application Accepted B z-- Date 1,D/, 'v Area Jr li Employee ID#D_ Final Inspection By. Date 48 E SPECIAL PERMIT -Approved by Character of Soil to Depth of 3 t: Pi S mp Soil Character: COMMENTS 2v -J 1-06Neel C{e h Yvl, 6%df- nd 10115 on "OW S P16,12 61fc k PE SC ReceivedChec Amount Code INFO B ash Remitted Date Permit/ Service Request # Invoice # Permit ID# 3 S-31 1360 io-1-20 S 00 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4114/18 T v.