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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-KEFUNDABLE PERMIT GALL ZUS) 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUE JOB ADDRESS ola O 1 1 CITYI IZIP CROSS STREETU> I APN ��1)J V — 3 OI 13 PARCEL SIZE S OWNERNAME PHONE (J0(J0)-3S_1-232L4OWNER ADDRESS QIN kk CITY/STATE/ZIP1,1*1\6 A. ga /O CONTRACTOR M PHONE d fi � � 9 "j — 6 (D CONTRACTOR ADDRESS PO I7OX a rll CITY/STATE/ZIP LAI) 6A• 9SRL4 LICENSE ❑ C42 [1-C-36 OTHER R (/ NUMBER 46), EXPIRATION DATE I) — fin— o\a'aa D ❑ LEACH LINES LEACHING CHAMBERS # OF LINES LENGTH OF LINES ft DISTANCE TO NEAREST WELL ft FOUNDATION W TER TABLE DEPTH: ' ft GEOGRAPHICAL INFORMATION: Coordinates X Y PERC TEST # BUILDING PERMIT # ft LENGTH LAND USE APPLICATION # ao'2006cl. l TYPE OF WORK- NEW INSTALLATION REPAWADDITION - ENGINEER DESIGNED /ALTERNATIVE DISTANCE TO NEAREST REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM - I DESTRUCTION INSTALLATION WILL SERVE: i RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ SEPTICTANK TYPEIMFG CAPACITY gal #OFCOMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS ft FOUNDATION DISTANCE TO NEAREST: WELL It FOUNDATION It PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) ❑ LEACH LINES LEACHING CHAMBERS # OF LINES LENGTH OF LINES 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. "E�410vr1VED 092022 „ry CO IJ VNn, Application Accepted By —M Date �/ < < Area I Employee ID# yy--4T Final Inspection By Y hrx�(.j S LJJ_-.-G9 n 9 Date — C SPECIAL PERMIT -Approved by Character of Soil to Depth of 3 Ft: PIt/Sump Soil Character: COMMENTS DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ FILTER BED WIDTH ft LENGTH hec ash 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 It LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ DISPOSAL PONDS WIDTH It LENGTH It DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTYLINE ft ❑ SEEPAGE PITS NUMBER WIDTH It DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTYLINE 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. "E�410vr1VED 092022 „ry CO IJ VNn, Application Accepted By —M Date �/ < < Area I Employee ID# yy--4T Final Inspection By Y hrx�(.j S LJJ_-.-G9 n 9 Date — C SPECIAL PERMIT -Approved by Character of Soil to Depth of 3 Ft: PIt/Sump Soil Character: COMMENTS PE SC Code INFO Received B hec ash Amount Date Permit/ Invoice # Permit ID# emitted Service Re uest# y2 2 s z-3 Ul 42-01 4/14/18 fl� • Y J V ONSITE WASTEWATER TRTMNT SYSTEM PERMIT