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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 I4UN-r1rrUNUAtsLt r-tKMI I ALL (--UY) YOd-/DY/ FUR INSPECTIONS tXPIRES I TEAR FHUM DATE ISSUEI JOB ADDRESS I 5PI 6L M Ogre-CITY/71p O REPAiR/ADDMON ENt>IIIEMDESIGNED/ALTER`N=T1VFa. / K'Cwkf►lM0 - D�0 - OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION Zfp-ki7,W1 CROSS STREET K.C.. All SUE WA _ C �IPARCEL }/ OWNER NAME SEPTICTANK k1 1L CAPACITY c�,V[J/y gal #OFCAMPARTMENTS ❑ GREASETRAP TYPE/MFG//�� CAPACITY gal #OFCOMPARTMENTS OWNER ADDRESS. C TY/STATEMP R FOUNDATION S i ft PROPERTYLINE 7/ ft CONTRACTOR _ C LIFT STATION 9 R _ _ O PKG TX PLANT O SAND OIL SEPARATOR (ENCLOSED SYSTEM) SOki LEACH LINES LEACHING CHANWRIS CONTRACTOR ADDRESS 19 ✓' CRY/SATEMP /` `COTANCE TO NEAREST WB.L—/OQ ft FOUNDATION ��/ ft PROPERTY LINE� 1 ft LICENSE hC-42 .� C -M OTHER _ FILTER BED _ NUMBER �+� EXPIRATION DA.—T:: ft DEPTH ft WATER TABLE DEPTH: __ ft GEOGRAPHICAL INFORMATION: Coordinates X Y _ i I HrMI1T Gr?1VIFI INA I I MAW: PNtPAREU TH15 APPLICATION AND THE WORK WILL BE DONE N ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. MINIMIIM AR HIiIIR Anl/ANCF Att ITIrF RFnIIIRFn F7117 11UCOFCTI1'1NC - Of FACF CAI 119/101 049-7,907 SIGNED Application Accepted By Final Inspection By„ Character of Soil tooDD,eptl COMMENTS /!-,6- T7y?-t.04 I P RTMENT S Y ', Date O 9Area "( Employee ID# " ✓ Date Ii�j � 1 C SPEC AL PERMIT - Approved by _ PM/li6an, Soil Character: -- * B" ' " Invoice# Permit ID# Code INFO _ BY ,Remitted , Service Request # 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18 PERC TEST t BUILDING PERMfT # LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION REPAiR/ADDMON ENt>IIIEMDESIGNED/ALTER`N=T1VFa. / REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION Zfp-ki7,W1 INSTALLATION WILL SERVE: X RESIDENCE COMMERCIAL OTHER _ NUMBER OF BEDROOMS: 'T NUMBER OF EMPLOYEES: NUMBER OF LIVING UNITS: _ j// SEPTICTANK -- G�. TYPE/MFG Q rl'e CAPACITY c�,V[J/y gal #OFCAMPARTMENTS ❑ GREASETRAP TYPE/MFG//�� CAPACITY gal #OFCOMPARTMENTS DISTANCETO NEAREST: WELL /I//�1JV' R FOUNDATION S i ft PROPERTYLINE 7/ ft ❑ LIFT STATION SUE TYPE OF PIMP O PKG TX PLANT O SAND OIL SEPARATOR (ENCLOSED SYSTEM) ❑ LEACH LINES LEACHING CHANWRIS i #OFUNEs C LENGTH OF LINES ft /` `COTANCE TO NEAREST WB.L—/OQ ft FOUNDATION ��/ ft PROPERTY LINE� 1 ft ❑ FILTER BED WmH R LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY UNE ft ❑ MOUNDED WIDTH It LENGTH ft DEPTH It DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY UNE ft SUMPS WIDTH �' ft LENGTH /# i ft DEPTH 8, It DISTANCE TO NEAREST WELL IC70 / It FOUNDATION R PROPERTYUNft ❑ DISPOSAL PONDS WIDTH It LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY UNE it ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft DISTANCE TO NEAREST WELL _ ft FOUNDATION It PROPERTY UNE ft I HrMI1T Gr?1VIFI INA I I MAW: PNtPAREU TH15 APPLICATION AND THE WORK WILL BE DONE N ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. MINIMIIM AR HIiIIR Anl/ANCF Att ITIrF RFnIIIRFn F7117 11UCOFCTI1'1NC - Of FACF CAI 119/101 049-7,907 SIGNED Application Accepted By Final Inspection By„ Character of Soil tooDD,eptl COMMENTS /!-,6- T7y?-t.04 I P RTMENT S Y ', Date O 9Area "( Employee ID# " ✓ Date Ii�j � 1 C SPEC AL PERMIT - Approved by _ PM/li6an, Soil Character: -- * B" ' " Invoice# Permit ID# Code INFO _ BY ,Remitted , Service Request # 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18