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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-KEFUNDABLEFERMIT ft GEOGRAPHICAL INFORMATION: Coordinates X Y L;ALL (ZU,9).90J-/by/ FOR INSPECTIONS tXPIRES l YEAR FROM UATE ISSUE JOB ADDRESS 6? 3 CROSS STREET Al- F� CITY/ZIPzfce APN O �0 1 , L O s' PARCEL SIZE �y I E3 OWNER NAME I OSP Pzp)l<e PHONE OWNER ADDRESS SG1I'OF CITY/STATE/ZIP /� CONTRACTOR _ (411 61 V�( l �Silr%7/ C PHONE do e - ��k% /� - 50,0 rJ y�/ Q a/ CONTRACTORADDRESS �(/ 317�� tJ y�c'l [r- CITY/STATE/ZIP _51C�Ia'�, AG1 LICENSE ❑?/ -42 ❑I !C-36 OTHER NUMBER 7,5 EXPIRATION DATE D7 WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # TYPE OF WORK: LI NEW INSTALLATION' I L REPAIR/ADDITION L ENGINEER DESIGNED / LTERNATIVE Invoice # Permit ID# REPLACEMENT G I� F (�j I 1 OUT -OF -SERVICE SEPTIC SYSTEM QC DESTRUCTION I I tj INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTHER 1 45[0 NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: ✓ NUMBER OF EMPLOYEES: SEPTIC TANK TYPE/MFG �1CF L CAPACITY /,�2oG gal # OF COMPARTMENTS C') ❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS 4 3.0 YO DISTANCE TO NEAREST: WELL t100 ft FOUNDATION ft PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) LEACH LINES LI LEACHING CHAMBERS # OF LINES LENGTH OF LINES SS ! ft DISTANCE TO NEAREST WELL BOO ft FOUNDATION 50 ft PROPERTY LINE 30 ft ❑ FILTER BED WIDTH ft LENGTH ft 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 ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft SEEPAGE PITS NUMBER .3 WIDTHZf a It ft DEPTH a5 I ft �y�' DISTANCE TO NEAREST WELL /5 v ft FOUNDATION /00 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 4.8 HOUR ADVANCE NOTICE REQUIR&Q REQUIREFOR INSPECTIONS - PLEASE CALL 209 953-7697 SIGNED llyTITLE Cor? GC DATE 6- S- as T J / DEPARTMENT USE ONLY ""I Application Accepted By ��/G v ` Date ? Area Employee ID# Final Inspection ByT�/ti�(NI� l��wi1L i- a.y1. Date_ ir( �� L� El SPECIAL PERMIT -Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS OndfflWiY7,ea,f e- LYLA ril 1)Ans 4� be ��hG�i7nPC� PE Code SC INFO Received By ec ash Amount Remitted ate Permit/ Service Request # Invoice # Permit ID# 45[0 �}-146 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18 7A