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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 I ION-KEFUNDABLE toERMIT GALL (LUy y53 -/6y/ FOR INSPECTIONS EXPIRES 'I YEAR FROM UATE ISSUE JOB ADDRESS Cj / aft CITY/ZIPI �� CI ( ? _ CROSS STREET _ 5 l 1 , G� C L� D /APN ^ 7-2-0-17 PARCEL SIZE Li. J OWNER NAME D 4t:4 171V (Tei-- �� ✓CG PHONE OWNER ADDRESS J / Q CITY/STATE/ZIP �` {� CONTRACTOR C V��'IT�L'� I �/ � L ` ' / /QC' r � PHONE c90� — �� cl — 5-V l� / CONTRACTOR ADDRESS 3 / T (0 �� aq /"( /((" _(J� ` CITY/STATE/ZIP LICENSE ❑IIC-42 [11"1 ✓I IC -36 OTHER NUMBER CqO EXPIRATION DATE WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: ❑ PERC TEST # BUILDING PERMIT # TYPE OF WORK: CI NEW INSTALLATION REPAIR/ADC Coordinates X LAND USE APPLICATION #_ >N E ENGINEER DE; REPLACEMENT I OUT -OF -SERVICE SEPTIC SYSTEM %. L DESTRUCTION INSTALLATION WILL SERVE NUMBER OF LIVING UNITS RESIDENCE I ❑ COMMERCIAL UMBER OF BEDROOMS: 3 91 OTHER NUMBER OF EMPLOYEES: SEPTIC TANK TYPE/MFG "� I CAPACITY 00LI)gal Service Re est # # OF COMPARTMENTS 12 ❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS DISTANCE TO NEAREST '^I PN C P -,t r C ft FOUNDATION _ d ft DISTANCE TO NEAREST: WELL C/ ft FOUNDATION /01 ft PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) 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. IVIIIVIMUIVI "FU II`V�VR HU VMIV I'G IVUl I IIrL RL VIIx CL/ vwrx IIYJrCIr I Iw1vo - rLC/-IJC %-mL-L. LUJ vu3-1 U.71 J40Z SIGNED _�' TITLE C)01/ 4C r DATE e -aq- 4;'� DEPARTMENT USE ONLY Application Accepted By Date 29 Z Area / / Employee ID# Final Inspection By k ° Date!%'�► �� ❑ SPECIAL PERMIT -Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS!�7QH'/o nnuhn!y -jr m/ e 2XiS/r., LC- el.0 LEACH LINES LI LEACHING CHAMBERS Service Re est # # OF LINES l LENGTH OF LINES �s ft DISTANCE TO NEAREST WELL P -,t r C ft FOUNDATION ft PROPERTY LINE /O 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 i a 1 ft DEPTH J� ft DISTANCE TO NEAREST WELL (y ft FOUNDATION U ft PROPERTY LINE /D 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. IVIIIVIMUIVI "FU II`V�VR HU VMIV I'G IVUl I IIrL RL VIIx CL/ vwrx IIYJrCIr I Iw1vo - rLC/-IJC %-mL-L. LUJ vu3-1 U.71 J40Z SIGNED _�' TITLE C)01/ 4C r DATE e -aq- 4;'� DEPARTMENT USE ONLY Application Accepted By Date 29 Z Area / / Employee ID# Final Inspection By k ° Date!%'�► �� ❑ SPECIAL PERMIT -Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS!�7QH'/o nnuhn!y -jr m/ e 2XiS/r., LC- el.0 42-01 GryZ !1 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18 VVV Service Re est # 42-01 GryZ !1 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18 VVV