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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 ft GEOGRAPHICAL INFORMATION: Coordinates X Y GALLZU//9 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUEI JOB ADDRESS7z k LENGTH OF LINES %OU /� ft -� VV` ll✓3-rt T 1 /� CITY/ZIP / j%� TYPE OF WORK: NEW INSTALLATION C REPAIR/ADDITION ENGINEER DESIGNED /ALTERNATIVE WELL r- ft A � G � INSTALLATION WILL SERVE: P<RESIDENCE ❑ COMMERCIAL ❑ OTHER CROSS STREET 4I SEPTIC TANK APN y 0 PARCEL SIZE OWNER NAME 1 ! P"CJo f del- 47 PHONE ❑ LIFT STATION OWNER ADDRESSC^ c, /7 l CITY/STATE/ZIP 1 fC/1 VI Vl yV/ CONTRACTORGi?/ 4-w'/ ❑ PHONE WIDTH ft LENGTH CONTRACTOR ADDRESS DEPTH ft �LL1' �' CITY/STATE/ZIP _5/164.t J/ LICENSE ❑k-_42 ❑ C-36 OTHER NUMBER EXPIRATION DATE 07� FOUNDATION ft PROPERTY LINE ft WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # # OF LINES_ LENGTH OF LINES %OU /� ft BUILDING PERMIT # 3`10S34-0 LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION C REPAIR/ADDITION ENGINEER DESIGNED /ALTERNATIVE WELL r- ft REPLACEMENT 1 OUT -0F -SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: P<RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: 4I SEPTIC TANK / TYPE/MFG CAPACITY / �� gal # OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS DEPTH ft DISTANCE TO NEAREST: WELL Z.SO % ft FOUNDATION ft PROPERTY LINE lop ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) Q� LEACH LINES _I LEACHING CHAMBERS Received # OF LINES_ LENGTH OF LINES %OU /� ft to Permit/ Service Request # Invoice # DISTANCE TO NEAREST WELL r- ft FOUNDATION -36 ft PROPERTY LINE /00 ! 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 WIDTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION 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. SIGNED DATE _ DEPARTMENTUS ONLY Application Accepted By �� Date Area Employee ID# As Final Inspection By �/Icts 'S C� � ir�a �7, Date �JZV Z"2i ❑ SPECIAL PERMIT -Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS /�eVJ SF-rl- -TiF'r --n,- PE t PE Code SC INFO Received Check#/ ash Amount Remitted to Permit/ Service Request # Invoice # Permit ID# 11 / D � lIPP) c.noyqffi 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18 r