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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 GALL ZUU `J0J-/DY1 FOR INSPECTIONS tXXPIKE5 T ThAR FROM ILIA _It 155Ut WILL SERVE: RESIDENCE COMMERCIAL Joe ADDRESS 4432 Viralt NUMBER OF LIVING UNITS: NUMBER OF BED OOMS: CrrY/ZIP_SS'II ),dun 1 _ �( 1 Lf -41 ��L CROSS STREET SEPTIC TANK APN 9/ 1 PARCEL SIZE / I OWNER NAME • )C,(�r ` C1 GREASE TRAP PHONE CAPACITY OWNER ADDRESS CrrY/STATEIZIP DISTANCE TO NEAREST: WELL I�' /� �/�1�� -1{ �I i II/�M t� I� �O� 2 1 �Q CONTRACTOR ` —I IL . PHONE '-'-J-q •� �II��UjLI.O'�/? v`wHQ #OF LINES hVChJ�• T yy\' CONTRACTOR ADDRESS ✓.7 I� 0-xVV\xk\ CITYISTATFJZIP 7 {Szi tJ fl PROPERTY UNE ft ❑ �t 15-1 2v, LICENSE C-42 C36 OTHER T► NUMBERS51 EXPIRATION DATE WATER TABLE DEPTH: PERC TEST # TYPE OF WORK: ft GEOGRAPHICAL INFORMATION: Coordinates X Y BUILDING PERMIT # LAND USE APPLICATION # NEW INSTALLATIONL � `, REPAIR/ADDITION ENGINEER DESIGNED iAL\TERNATNE / REPLACEMENT l�L: T F� OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION 1 rM1Y IL INSTALLATION WILL SERVE: RESIDENCE COMMERCIAL OTHER NUMBER OF LIVING UNITS: NUMBER OF BED OOMS: NUMBER OF EMPLOYEES: / _ �( 1 n r� , `yy F� SEPTIC TANK TYPE/MFG CAPACITY (Jai # OF COMPARTMENTS El GREASE TRAP TYPE/MFG I CAPACITY gal # OF COMPARTMENTS DISTANCE TO NEAREST: WELL ft FOUNDATION R PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP O PKG TX PLANT O SAND OIL SEPARATOR (ENCLOSED SYSTEM) ❑ LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft DISTANCE TO NEAREST WELL ft FOUNDATION fl PROPERTY UNE ft ❑ FILTER BED WIDTH It LENGTH ft DEPTH It DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It ❑ MOUNDED WIDTH ft LENGTH ft DEPTH It DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY UNE It ❑ SUMPS WIDTH It LENGTH ft DEPTH It DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY UNE ft ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH It DISTANCE To NEAREST WELL ft FOUNDATION ft PROPERTY LINE It 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. Application Accepted By Final Inspection By Character of SolI to Dept COMMENTS e i p ,vl '-Pa S u irk 42-01 4/14/18 1® 2021 UJIV %`MP �V N7Y PERMIT - Approved by ONSITE WASTEWATER TRTMNT SYSTEM PERMIT