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r ` IC)N•bs7pTE WASTEWA3 E11'q 14 RI'.o,ATMRKY H SYSTEM�� !I E1FT!3RT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1 868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 "7 NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES I YEAR FROM BATE ISSUED JOB ADDRESS //KS/ ti 62 '(�S'r l(:IYI — CITY/ZIP !3!5220L f CROSS STREET �G� r t/Yi%/ I d Ct APNPARCEL SIZE OWNER NAME DL' 17ym e _�Crl�G _--PHONE 2O 3 N OWNERADDRES 74JCITY/STATEIZIP CONTRACTOR— PHONE CONTRACTOR ADDRESS W h e k— CITY/STATEIZIP LICENSE C71-IC-42 LII IC-36 OTHER, NUMBER ExPIRATION DATE 'WATER TABLE DEPTH: ft GEOGRAPHICAL_INFORMATION: Coordinates iv_ Y rr 0 FERC TEST # BUILDING PERMIT#'. LAND USE APPLICATION# TYPE OF WORK: >e— NEW INSTALLATION G R AIR/ADDITION CI ENGINEER DESIGNED/ALTERNATIVE I REPLACEMENT II OUT-OF-SERVICE SEPTIC SYSTEM I_I DESTRUCTION INSTALLATION WILL SERVE: F_l RESIDENCE COMMERCIAL ❑ OTHERfwx=cjA :7 NUMBER OF LIVING UNITS:_ NUMBER OF BEDROOMS: _ -- r NUMBER OF EMPLOYEES: SEPTIC TANK TYPE/MFG y CAPACITY gal #OF COMPARTMENTS 1 GREASE TRAP TYPE/MFG _ CAPACITY gal #OF COMPARTMENTS DISTANCE TO NEAREST: WELL ft FOUNDATION O`fi ft PROPERTY LINE r-7 l LIFT STATION SIZE —'TYPE OF PUMP- __ - 17 PKG TX PLANT M SAND OIL SEPARATOR.(ENCLOSED SYSTEM) VUA-t. PunkS -w1 AtoPto V(SLAA— AtAeN . �( LEACH LINES x LEACHING C! AMBERS #OF LINES LENGTH OF LINES -75Pft DISTANCE TO NEAREST WELL1 tfi_ ft FOUNDATION I I'f ft PROPERTY LINE �rr ft Q FILTER BED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL_— ft FOUNDATION _ ft PROPERTY LINE_ ft 17, MOUNDED WIDTH ft LENGTH ft DEPTH ft l DISTANCE'TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft SUMPS ('Coo) WIDTH � ft LENGTHt 1+ ft DEPTH t Z ft DISTANCE TO NEAREST WELL. T ft FOUNDATION II IG �� ft PROPERTY LINE ft DISPOSAL PONDS WIDTH ft LLNGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft SEEPAGE PITS NUMBER WIDTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft I HEREBY CERTIFY THAI'[HAVE PRIF ARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE 1NITH SAN JOAQUIN COUNTY ORDINANCES, TE LAUDS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. I u HOUR A SFA CE NO€ICS -a t--0 'fNS Tl 5 - ASE CALL (2Q)9),953-7 6�1 l SIGNS — TITLEDATE /9 ry 12ZP SE 11L Y Application Accepted B _ — _ Date_ / Flrea � Employee ID#__ Final Inspection By Date0 ',Ii',I-,PERR41T-Approved l)y Character of Soil to Depth Of 3 Ft:— Pit/SLHnp Soil Character: COMMENTS p s0M �GIL� Old-- -�'fa� PE SC' Received Check#/ Amount Date Permit/ Invoice# Permit ID# Cod. INFO By Cash tRelpitted Service Re Uest# 42-01 019SITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18