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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 (:ALL ZUY `J03-10YI FOR INSPECTIONS CXPIRES "I TEAR FROM UAFE ISSUtI JOB ADDRESS 392 NE CIITY/ZIPF?ENCN Mme 'T;1-7/ CROSS STREET el 5e APN l %Q 37,290-4-/ —PARCEL SIZE O, �,/O OWNER NAME A'ZmAaDO 1A V1 (-A PHONE q�-a -n47/- S`' n OWNER ADDRESS 571 EA'S/( %C%ZEL L- -//�/�E CITY/STATE/ZIP n Eiyep (!*,n '' QA �S � If CONTRACTOR �e -41ES AI£ y "rJ Su1--f2 V L1 PHONE C V 9 - ¢OZ- /; s a /, CONTRACTOR ADDRESS l%TSe h71 CITY/STATE/ZIP 'T �i gLoz-y-I CA fj 5-36 I LICENSE 111_'C-42 111',C-36 OTHER NUMBER (/'s47q EXPIRATION DATE (p A'a /s�3 WATER TABLE DEPTH: ti aU ft GEOGRAPHICAL INFORMATION: Coordinates X Y PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # TYPE OF WORK: ❑ NEW INSTALLATION G REPAIR/ADDITION C ENGINEER DESIGNED /ALTERNATIVE I I REPLACEMENT I ) OUT -OF -SERVICE SEPTIC SYSTEM C DESTRUCTION INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPE/MFG ❑ GREASE TRAP TYPE/MFG CAPACITY CAPACITY DISTANCE TO NEAREST: WELL ft FOUNDATION _ ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ LEACH LINES —' LEACHING CHAMBERS I HEREBY CERTI # OF LINES b gal # OF COMPARTMENTS gal # OF COMPARTMENTS _ ft PROPERTY LINE ft ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) DISTANCE TO NEAREST WELL FILTER BED WIDTH ft PROPERTY LINE ft FOUNDATION DISTANCE TO NEAREST WELL MOUNDED WIDTH FOUNDATION ft DEPTH DISTANCE TO NEAREST WELL SUMPS WIDTH ft PROPERTY LINE ft DISTANCE TO NEAREST WELL DISPOSAL PONDS WIDTH ft FOUNDATION DISTANCE TO NEAREST WELL SEEPAGE PITS NUMBER DISTANCE TO NEAREST WELL I HEREBY CERTI # OF LINES b gal # OF COMPARTMENTS gal # OF COMPARTMENTS _ ft PROPERTY LINE ft ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) LENGTH OF LINES ft FOUNDATION LENGTH DEPTH ft ft PROPERTY LINE ft FOUNDATION LENGTH ft PROPERTY LINE ft DEPTH ft FOUNDATION LENGTH DEPTH ft ft PROPERTY LINE ft FOUNDATION LENGTH ft PROPERTY LINE ft ft FOUNDATION WIDTH ft FOUNDATION LENGTH OF LINES ft ft PROPERTY LINE ft DEPTH ft ft PROPERTY LINE ft DEPTH ft ft PROPERTY LINE ft DEPTH ft ft PROPERTY LINE ft DEPTH ft ft PROPERTY LINE ft DEPTH ft ft PROPERTY LINE ft 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. IVILII'VI"m -ry 11 V v/'11YlrL IYV I f%.,RL 1JIRG✓ rVR IIY J!"G,/V I IVIYJ -- rLC/•IJG LI/YL-L- I 4V.7 .Y.7J / uulr q SIGNED TITLE (tel Y/L �/YG�iVF�J� DATE oZ - —I—� DEPARTMENT.USF ONLY Application Accepted Byy�—T Date Area Final Inspection By 1'1 Date ❑ SPECIAL PERMIT - Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS SEP 13 26_ "RONMENTA► N E PE Code SC INFO Received By hec ash Amount Remitted Date Permit/ Service Request # Invoice # Permit ID# ��aa 2 sa3 FIs 9-13-2 0095 -1 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18 T