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n ONSITE WASTEWATER TREATMENT SYSTEM PERMIT S,AN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 .(209) 468-3420 NON-REFUNDABLE PERMIT L LL (ZU9) 953-1697 FOR INSPECTIONS EXP IRES 1 YEAR FROM DATE ISSUE JOB ADDRESS / Q =,.) / ` /' CrrY/ZIP pp, CROSS STREET //L� 1IG^ Fh APIN J 2 Zy Z �'Y PARCELSIZE OWNER NAME PHONE OWNER ADDRESS CONTRACTOR_G(!J/J/C� �`;-J-t� �%� L SI JC --✓moi' PHONE ff CONTRACTOR ADDRESS /L/L, �f; /'UL1 C`" —CITY/STATE/ZIP � `'(�(' L '7" /'13-S J LICENSE ❑OC -42 ❑OC -36 OTHER ! I NUMBER -7/ -� 3 EXPIRATION DATE �/ / J `-' ! = " 1 1N. -Two, c n.. - v\`1 H Gonmowowru D ❑ PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # TYPE OF WORK: D NEW INSTALLATION fF REPAIRIADDITION , ❑ ENGINEER DESIGNED /ALTERNATIVE U REPLACEMENT Ll OUT -OF -SERVICE SEPTIC SYSTEM � - DESTRUCTION INSTALLATION WILL SERVE: ® RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: C r�NUMBER OF EMPLOYEES: SEPTIC TANK TYPE/MFG 1 OI,APACITY J ( 1 gal # OF COMPARTMENTS /❑U GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS DISTANCE TO NEAREST: WELL R FOUNDATION It PROPERTY LINE It ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) ❑ LEACH LINES IRS' LEACHING CHAMBERS l Cl-' S 1,, # OF LINES LENGTH OF LINES Cl-- - It DISTANCE TO NEAREST WELL ?? ft FOUNDATION ft PROPERTY LINE I" It ❑ FILTER BED WIDTH It LENGTH ft DEPTH It DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft ❑ MOUNDED WIDTH If LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft ❑ SUMPS WIDTH It LENGTH It DEPTH If DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE It ❑ DISPOSAL PONDS WIDTH It LENGTH ft DEPTH It DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ZI SEEPAGE PITS NUMBER 7 WIDTH —S' It DEPTH '- ft DISTANCE TO NEAREST WELL It FOUNDATION It PROPERTY LINE ft 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. MINIMUM 488HDUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 SIGNED '/. 4,__- TITLE DATE _ / / Z6/2 i Z Application Accepted By Final Inspection By Character of Soil to Depth of 3 COMMENTS Pit/Sump Soil rea — / ' I Employee ID#7 SPECIAL PERMIT -Approved by PE SC Received Check#/ Amount Permit/ Code INFO B Cash Remitted Date Invoice # Permit ID# Service Request # 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18