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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-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS I C,/ZIP_1 iic'_4 v CROSS STREET Lj APN DSS-09 O - 33 PARCEL SIZE D- ` V � c OWNER NAME .`liG p '// p� /0' 7r PHONE OWNER ADDRESS v any v CRY/STATE21P/ CONTRACTOR 7 'll? J /- -7,r PHONE @;•%' S U 4 7 CONTRACTOR ADDRESS I- �yl-, ` !C./"�1'_KJ /f/i/G 9/46RY/STATE12JP'S LP[/ LICENSE DK2 D C-36 OTHER NUMBER %PIRATION DATE4 /2ti� WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y D PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: NEW INSTALLATION REPAIRIADDITION ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM I DESTRUCTION INSTALLATION WILL SERVE: )d?�-RESIOENCE D COMMERCIAL �j D OTHER NUMBER OF LMNG UNITS: I t- NUMBER OF BEDROOMS: J NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPE/MFG LAS 5 Wi CAPACITY gal #OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal ft OF COMPARTMENTS DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE It ❑ LIFT STATION SIZE TYPE OF PUMP O PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEtup 1116 -LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft DISTANCE TO NEAREST WELL NJ"t- fl FOUNDATION �i�i ft PROPERTYLINE h ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE ft ❑ MOUNDED WIDTH It LENGTH It DEPTH ft x(� �-U DISTANCE TO NEAREST iWELL ft FOUNDATION h PROPERTYLINE ft ( / A,V-n 1 SUMPS WIDTH "-'/ ��R['� LENGTH ft DEPTH /0 ' ft 7 Y DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE h ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH h DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTYLINE ft ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft DISTANCE TO NEAREST WELL IT FOUNDATION ft PROPERTY LINE ft I HEREBY CERTIFY THAT 1 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. MINIMM 48 HO R ADVANCE NOTICE REQUIRED FOR INSPECTIONS- LEASE CALL 209 953-7697 SIGNED �� /` TITLECfi! '' CSC DATE MENT FIVE® V R- 0 1 2024 UIN COUNTY lb NMENTq� EPARTMENT DEPARTMENT USE ONLY 9 /J Application Accepted B Date Area • Employee ID# /r'r Final Inspection By ate 9 Pt??--z G SPECIAL PERMIT-Approved by Character of Soil to Depth of 3 t: Pit/Sump Soil Character: C'O'MMENTS AAA-10 V ��7 011 O bf4W«/7 Z CC It'll-CA f^'4-S �Gaw� QI e I.!rno /O O.0� / C R/7 !O/1t. A-7 00/010VI""; tr- LA-V1 4tr Zdc -r- PE PE SC Received Check#/ Amount D to Permit! Invoice# Permit ID# Code INFO Ca Remitted Service f1eqUest 5/210 IIS �`(o 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14118