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dMAILE® <br /> M <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1 86B E.HAZELTON AvENUE-STOCKTON CA 95205-(209)4683420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPLIRES 9 YEAR FROM DATE ISSUED <br /> JOB ADDRESS I� ry 5, rC LL /1 CITYIIJP 4 V��'rV'� � _Z 15 <br /> CROSS STREET 0 t ��L f S APN C��`�j�` `d G1 PARCEL SIZE <br /> OWNER NAME_ / S t+'F t` �r}�_i� -�P�NOj�NE <br /> OWNER ADDRESS�^f &[t(�5" F��� dICTn- CITYISTATER%IP `,zy/"-ht'��� °�}Jr'rS�7�,eZ 1! y <br /> CONTRACTOR Pt a� f,65tV Y. t�t. -(IA+� a £�� PHONE d.- ✓ Aw � ""r./ <br /> CONTRACTOR ADDRESS ' - �7 fr(+1'�.r r-t CITY/S7ATEJZIP `tit <br /> LICENSE CC-42 ❑CC-36 OTHER — NUMBER i t "-��` EXPIRATION DATE <br /> WATER TABLEFDEPTH: it GEOGRAPHICAL INFORMATION: Coordinates X Y. <br /> 0 PERC TEST # BUILDING PERMIT# LAND USE APPLICATION#_ <br /> TYPE OF WORK, 0 NEW INSTALLATION 0, REPAIRIAWTION 0 ENGINEER DESIGNED/ALTERNATIVE <br /> D REPLACEMENT U OUT-OF-SERVICE SEPTIC SYSTEM U DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL 0 OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPEIMFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASETRAP TYPE/MFG CAPACITY gal #OFCOMPARTMENTS <br /> DISTANCE TO NEAREST: WELL 11 FOUNDATION it PROPERTY LINE R <br /> ❑ LIFT STATION SIZE TYPE OF PUMP O PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> �[ y� f d7 �irs C <br /> LEACH LINES ❑ LEACHING CHAMBERS y,_ #OF LINES LENGTHOFUNES50' ''-64 Yt Z. <br /> it <br /> DISTANCE TO NEAREST WELL�'T N FOUNDATION '� ft PROPERTY LINE it <br /> ❑ FILTER BED WIDTH it LENGTH 8 DEPTH it <br /> DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTYLINE I'll <br /> ❑ MOUNDED WIDTH H LENGTH It DEPTH it <br /> DISTANCE TO NEAREST WELL N FOUNDATION it PROPERTYLINE R <br /> ❑ SUMPS WIDTH R LENGTH R DEPTH it <br /> DISTANCE TO NEAREST WELL it FOUNDATION R PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH it LENGTH R DEPTH it <br /> DISTANCE TO NEAREST WELL it FOUNDATION R PROPERTYLINE it <br /> ❑ SEEPAGE PITS NUMBER WIDTH it DEPTH it <br /> DISTANCE TO NEAREST WELL it FOUNDATION R PROPERTY LINE it <br /> 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WALL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY 0 RUIN ANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> ! 48 HOU DMANCE NOT CE REQUIRED FOR INS EC IONS, LE S CALL 209 953- 69 <br /> SIGNED TITLE G .l-� +'I�✓ DATEZ'�Z� <br /> PgyMEN <br /> ECEIVE� <br /> NrAL <br /> gQU/N 2026 <br /> C� <br /> D p� <br /> NT <br /> i <br /> DEPARTMENT S k <br /> Application Accepted By At Date 17 Area Employee ID# <br /> Final Inspection Byl' _ Date ❑ SPECIAL P RMIT-Approved by <br /> Character of'Soil to epth of 3 F: Pi p Soil C cler: <br /> COtv1MENTS <br /> c512 .66eDie,~AAu I r o G <br /> PE SC Recelved I Check#/ I Amount Data I PermiU invoice# Permit[ON <br /> sCode INFO sh emitted Sarvlce Re uest# <br /> 42.01 //� ,�' ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4114118 <br /> Uploaded into Accela <br />