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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 HERMIT CALL LUY .903-/6y/ FOR INSPECTIONS EXPI Joss ADDRESS -,5- �G5from!�2hokf CITY/ZIP 1 CROSS STREET D I sc it,,) r2 2!WAPN ®� % � � 0 Z 9 %%J OWNER NAME "`)g111A eV - 6441 &J1' Lk e-0— PHONE OWNER ADDRESS CITY/STATE/ZIP 1 YEAR FROM DATE ISSUE PARCEL SIZE 'y" 4)/ CONTRACTOR uC•`l► Lf ( a/AlV/p^� PHONE — 3C( �— �Q�/ CONTRACTOR ADDRESS / -' ' - v'"`f /J� CITY/STATE/ZIP ` LICENSE ❑Vt-42 11❑C-36 OTHER NUMBER J c� EXPIRATION DATE �/ C; WATER TABLE DEPTH: `' ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT #800 -Z 6O & LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION ❑ REPAIR/ADDITION I1 ENGINEER DESIGNED /ALTERNATIVE ❑ REPLACEMENT ❑ OUT -OF -SERVICE SEPTIC SYSTEM 0 DESTRUCTION INSTALLATION WILL SERVE: X RESIDENCE ❑ COMMERCIAL11 [IOTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS:L-3/ NUMBER OF EMPLOYEES: SEPTIC TANK TYPE/MFG YfQZ6 CAPACITY [ ,;710 gal # OF COMPARTMENTS 1:;1 ❑ GREASE TRAP TYPE/MFG �^ CAPACITY /71 gal # OF COMPARTMENTS DISTANCE TO NEAREST: WELL o�CfC% ft FOUNDATION / V / ft PROPERTY LINE 60 ' ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) LEACH LINES t # ofLINES 3 � �5 , ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 NON-KEFUNDABLE HERMIT CALL LUY .903-/6y/ FOR INSPECTIONS EXPI Joss ADDRESS -,5- �G5from!�2hokf CITY/ZIP 1 CROSS STREET D I sc it,,) r2 2!WAPN ®� % � � 0 Z 9 %%J OWNER NAME "`)g111A eV - 6441 &J1' Lk e-0— PHONE OWNER ADDRESS CITY/STATE/ZIP 1 YEAR FROM DATE ISSUE PARCEL SIZE 'y" 4)/ CONTRACTOR uC•`l► Lf ( a/AlV/p^� PHONE — 3C( �— �Q�/ CONTRACTOR ADDRESS / -' ' - v'"`f /J� CITY/STATE/ZIP ` LICENSE ❑Vt-42 11❑C-36 OTHER NUMBER J c� EXPIRATION DATE �/ C; WATER TABLE DEPTH: `' ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT #800 -Z 6O & LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION ❑ REPAIR/ADDITION I1 ENGINEER DESIGNED /ALTERNATIVE ❑ REPLACEMENT ❑ OUT -OF -SERVICE SEPTIC SYSTEM 0 DESTRUCTION INSTALLATION WILL SERVE: X RESIDENCE ❑ COMMERCIAL11 [IOTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS:L-3/ NUMBER OF EMPLOYEES: SEPTIC TANK TYPE/MFG YfQZ6 CAPACITY [ ,;710 gal # OF COMPARTMENTS 1:;1 ❑ GREASE TRAP TYPE/MFG �^ CAPACITY /71 gal # OF COMPARTMENTS DISTANCE TO NEAREST: WELL o�CfC% ft FOUNDATION / V / ft PROPERTY LINE 60 ' ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) 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 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL 209 953-7697 SIGNED TITLE ��1' (%( DATE li-a9 _ -�>/ DEPARTMENT USIE ONLYKIY Application Accepted By Date 11 2-q '2 -Area 5 Employee ID# _ Final Inspection By Date 1112` 2,\ El SPECIAL PERMIT -Approved by Character of Soil to Depth of 3 Ft: it/Sump Soil Character: COMMENTS II,OA] 01-/eAk& 3 kd,--.�%i 3 b-14- 0"P 1 6 1t1 tAll,- l Al-tT4t,& 0)7.2 ; PWA PE Code LEACH LINES ❑ LEACHING CHAMBERS # ofLINES 3 LENGTH OF LINES �5 , ft Invoice # Permit ID# DISTANCE TO NEAREST WELL %?00 ft FOUNDATION O / ft PROPERTY LINE (p0 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 I SUMPS n WIDTH ` ft LENGTH I � ft DEPTH / y / ft DISTANCE TO NEAREST WELL 15 Of ft FOUNDATION 1 C 4 ft PROPERTY LINE ft ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO AREST WELL ft FOUNDATION ft PROPERTY LINE ftt NUMBER ft DEPTH DISTANCE TO AREST FOUNDATIO171 IINF 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 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL 209 953-7697 SIGNED TITLE ��1' (%( DATE li-a9 _ -�>/ DEPARTMENT USIE ONLYKIY Application Accepted By Date 11 2-q '2 -Area 5 Employee ID# _ Final Inspection By Date 1112` 2,\ El SPECIAL PERMIT -Approved by Character of Soil to Depth of 3 Ft: it/Sump Soil Character: COMMENTS II,OA] 01-/eAk& 3 kd,--.�%i 3 b-14- 0"P 1 6 1t1 tAll,- l Al-tT4t,& 0)7.2 ; PWA PE Code SC INFO Received BV Che Cash Amount Remitt d Dat I Permit/ Service Request # Invoice # Permit ID# 4A I :NT 'At;lA 01�_ ) ftgal " - 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18 T m Y 0 d M v.�