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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 (ZU,9) 953-/69/ FOR INSPECTIONS tXPIRE5 -1 T EAR 1 -ROM UA I E ISSUtI JOB ADDRESS /,�J ��/ f��6�/�j�/ ,L> "n %CITY/ZIP CROSS STREET ! I ' APIN O f O O PARCEL SIZE t� 7+ 07 1- i OWNER NAME I JU effi/I )0 y�PHONE7115� OWNER ADDRESS �� %r WC CITY/STATE/ZIP CONTRACTOR /C i l i��N /1 �l�n�I �°, v ` PHONE CONTRACTOR ADDRESS 1O !r bp'/AI �.� CITY/STATE/ZIP,' _�J IS / LICENSE )d—C-42 ❑ C-36 OTHER NUMBER EXPIRATION DATE�a-y WATER TABLE DEPTH: Q 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 DESTRUCTION INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: .4�- NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPE/MFG CAPACITY gal # OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS Permit ID# DISTANCE TO NEAREST: WELL 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_ LENGTH OF LINES ft DISTANCE TO NEAREST WELL ft FOUNDATION %��yC ft PROPERTY LINE l }- ft ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft SEEPAGE PITS NUMBER WIDTH ft DEPTH DISTANCE TO NEAREST WELL FOUNDATION y%�J, L ft 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. MINWOk 48 HOU DV NCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL 209 953-7697 TITLE DATE 27, SIGNED %' DEPARTMENT USE ONLY Application Accepted By —/" v Date Area Employee ID# Fr ✓I k Final Inspection By Date Z �- El PERMIT -Approved by Character of Soil to Depth 3 Fl: Pit/Sump Soil Character: COMMENTS Unl4nyWY1 %ier It EX1��iYl< ��>c� lilies Jo YPIWA07. PE Code Sc INFO Receivedc By Remitted ate Service Request # Invoice # Permit ID# 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18