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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^PVERMIT GALL 1U9 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUE JOB ADDRESS ! 2 U d� R� . /sof/^ J CITY/ZIP �/Jt: ✓/ S-1, i CROSS STREET /��C4 l I7 j C,t� APN 'Z�/ / �Y PARCEL SIZE J6, J S� OWNER NAME ��fS/l�.S�{'n�^ /PHONE OWNER ADDRESS CITY/STATE//ZIP A- ��" �• •X'v 1 T �� `� CONTRACTOR f�P/CSYiI•<- �Je�nA C J�c[� C/ PHONE/ T, CONTRACTOR ADDRESS /7 ` ✓ [/'N� C� �� CITY/STATE/ZIP- " 'mac/ `r / { J -%�✓ J-� LICENSE 11DC-42 ❑0C-36 OTHER NUMBER J 5�� EXPIRATION DATE �/� 2O/�O 2 WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED /ALTERNATIVE REPLACEMENT ❑ OUT -OF -SERVICE SEPTIC SYSTEM Ia/ DESTRUCTION INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: 2- SEPTIC TANK TYPE/MFG CAPACITY -/16c) J gal # OF COMPARTMENTS_ L3 GREASETRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS / DISTANCE TO NEAREST: WELL I J,7 ft FOUNDATION ft PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) ❑ LEACH LINES ❑ LEACHING CHAMBERS # OF LINES ft ft ft ft LENGTH OF LINES _ ft PROPERTY LINE DEPTH ft PROPERTY LINE DEPTH ft PROPERTY LINE DEPTH ft PROPERTY LINE DEPTH ft PROPERTY LINE DEPTH ft PROPERTY LINE 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 DATEZ— / Z� 3�j � DEPARTMENT USE ONLY Application Accepted By `-- /"— Zlz_ Date zlxzboa Area 1 i Employee ID#A -S Final Inspection By(1.15 , Date Z� 1 -2-1 ❑ SPECIAL PERMIT -Approved by Character of Soil to Depth of 3 Ft: PiVSump Soil Character: COMMENTS PE SC Code INFO DISTANCE TO NEAREST WELL Permit/ Invoice # Permit ID# is uest # ft FOUNDATION FILTER BED WIDTH ft LENGTH DISTANCE TO NEAREST WELL ft FOUNDATION _ MOUNDED WIDTH ft LENGTH DISTANCE TO NEAREST WELL ft FOUNDATION _ SUMPS WIDTH ft LENGTH DISTANCE TO NEAREST WELL ft FOUNDATION _ DISPOSAL PONDS WIDTH ft LENGTH DISTANCE TO NEAREST WELL ft FOUNDATION _ SEEPAGE PITS NUMBER WIDTH DISTANCE TO NEAREST WELL ft FOUNDATION ft ft ft ft LENGTH OF LINES _ ft PROPERTY LINE DEPTH ft PROPERTY LINE DEPTH ft PROPERTY LINE DEPTH ft PROPERTY LINE DEPTH ft PROPERTY LINE DEPTH ft PROPERTY LINE 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 DATEZ— / Z� 3�j � DEPARTMENT USE ONLY Application Accepted By `-- /"— Zlz_ Date zlxzboa Area 1 i Employee ID#A -S Final Inspection By(1.15 , Date Z� 1 -2-1 ❑ SPECIAL PERMIT -Approved by Character of Soil to Depth of 3 Ft: PiVSump Soil Character: COMMENTS PE SC Code INFO Received 10eckW Amount B Remitted ate Permit/ Invoice # Permit ID# is uest # H avf� s 13 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18