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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />` SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468.1420 <br />NON-KEFUNDABLE PERMIT <br />(:ALL lUt1 9J f-/ff9/ FOR INSPECTIONS <br />tXPIRES 7 YEAR FROM DATE ISSUEI <br />JOB ADDRESS 2 <br />0 <br />CITY/ZIP <br />I <br />ft PROPERTY LINE UZO ft <br />CROSS STREET V <br />APN <br />ft LENGTH It <br />3� I <br />( / Q <br />OWNER NAME � ',�el n n i <br />1[-,( <br />S � r1 r ._ <br />'LSI <br />h ! Y Imo. <br />'7PpARRCELSIZE <br />y8�S2 <br />PHONE2(A - Z9 1 - L ! N 3 <br />^/1 �( <br />/ <br />OWNER ADDRESS' `-.yyJ��0 I YV - 1,i1,, <br />/r-T�R 7o <br />11I I`uti(� <br />CITY/STATE/ZIP <br />Tm tq A <br />CONTRACTOR Own P ►' <br />DISTANCE TO NEAREST <br />PHONE <br />ft PROPERTY LINE ft <br />CONTRACTOR ADDRESS <br />WIDTH <br />CITY/STATE/ZIP <br />DEPTH It <br />LICENSE I ' C42 I I C-36 OTHER NUMBER EXPIRATION <br />WATER TABLE DEPTH: Le!Z *C1 V? 070 ft GEOGRAPHICAL INFORMATON: Coordinates X Y <br />F PERC TEST # SF,0QSWFBuiLDING PERMIT # - LAND USE APPLICATION # <br />TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE <br />REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION <br />INSTALL ATION WILL SERVE: M RESIDENCE 11 COMMERCIAL L� LI OTHER <br />&'0'NUMBER OF LIVING UNITS: i NUMBER OF BEDROOMS: 1 NUMBER OF EMPLOYEES: n <br />& SEPTIC TANK TYPEIMFG L Crd f CAPACITY (DD gal #OF COMPARTMENTS L <br />❑ GREASETRAP TYPEIMFGCAPACITY gal #OFCOMPARTMENTS <br />DISTANCE TO NEAREST: WELL1fi�rr,, 0 ft FOUNDATION ft PROPERTY LINE :aft <br />❑ LIFT STATION SIZE TYPE OF PUMP O PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />3/ LEACH LINES <br />YMENT7- <br />LEACHING CHAMBERS 1 # OF LINES <br />LENGTH OF LINES �C� ft <br />DISTANCE TO NEAREST <br />/ 2 <br />WELL �1% ft FOUNDATION ✓O <br />I <br />ft PROPERTY LINE UZO ft <br />❑ FILTER BED <br />WIDTH <br />ft LENGTH It <br />DEPTH ft <br />DISTANCE TO NEAREST <br />WELL ft FOUNDATION <br />R PROPERTY LINE ft <br />❑ MOUNDED <br />WIDTH <br />It LENGTH ft <br />DEPTH ft <br />DISTANCE TO NEAREST <br />WELL it FOUNDATION <br />ft PROPERTY LINE ft <br />❑ SUMPS <br />WIDTH <br />ft LENGTH It <br />DEPTH It <br />DISTANCE TO NEAREST <br />WELLIt FOUNDATION <br />ft PROPERTY LINE R <br />❑ DISPOSAL PONDS WIDTH <br />ft LENGTH ft <br />DEPTH ft <br />DISTANCE TO NEAREST <br />WELLIt FOUNDATION <br />It PROPERTY LINE ft <br />❑ SEEPAGE PITS <br />NUMBER <br />WIDTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST <br />WELL It FOUNDATION <br />ft PROPERTY LINE ft <br />I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br />STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br />ULNNUM 48 <br />SIGNED <br />HOUR ADVANCE <br />NQTICE REQUIRED FOR INSPECTIONS - <br />TITLE /)WhC.f <br />PLEASE CALL (209) <br />G <br />DATEe O <br />08 2022 <br />'MCA; <br />M� �UN�Y <br />P <br />Application Accepted By - `� Date % u N Y Area u Employee ID# <br />Final Inspection By Date L F1 SPECIAL PERMIT - Approved by <br />Character of Soil to Depth of 3 Ft: t1 ump Soil Character: <br />COMMENTS A)? -%J SFR -frPr ron-rep IY.. <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4/14118 <br />