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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 � ERMMIT CALL 209 953-7697 FOR INSPECTIONS y EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS ;2q)3d %� CITY/ZIP LV^�11.1% It523(o CROSS STREET ✓V^«^ �'�' APN Ior- 10-0uPARCEL SIZE e'0 aC' OWNER NAME - 1 0N L4 r�� PHONE toy r b fa _7lL Z " _ OWNER ADDRESS 2 Rr.:,.t Clever b-, CITY/STATE/ZIP C' s(L J�, CONTRACTOR x•t-4- PHONE Q01 of if 4b T,r Z 1 CONTRACTOR ADDRESS ^/�•� CITY/STATE/ZIP (! V g--z LICENSE Di.IC-42 ❑rC-36 OTHER NUMBER EXPIRATION DATE WATER TABLE DEPTH: 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: ESIDENCE L1COMMERCIAL L' OTHER �7 NUMBER OF LIVING UNITS: /. n / NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ;V'*SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS J ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS DISTANCE TO NEAREST: WELL ft FOUNDATION fl PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) J EACH LINES LEACHING CHAMBERS -— #OF LINES LENGTH OF LINES It DISTANCE TO NEAREST WELL ft FOUNDATION 7/f '•QTT� ft PROPERTY LINE / O T fl ❑ FILTER BED WIDTH ft LENGTH ft — DEPTH it DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft ❑ MOUNDED WIDTH ft LENGTH it DEPTH R DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ SUMPS WIDTH It LENGTH It DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION fl PROPERTY LINE ft ❑ DISPOSAL PONDS WIDTH It LENGTH ft DEPTH It DISTANCE TO NEAREST WELL It FOUNDATION It PROPERTY LINER T SEEPAGE PITS LIMB R WIDTH ft DEPTH b:� h DI NCE TON EST WELL ft FOUNDATION R PROPERTY LINE ft 1 HEREBY CERTIF 7TVE PRE RED THI APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES. STLAWSAND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. R ADAZE NOTICE REQUIRED FOR INSPECTIONS-PLEASE C LL 20 SIGNED1Y1 A TITLE d-U DATE Lb 741 117 -0 PAR TMENT USE O LY / � Application Accepted By Date AreaWCL % Employee ID# K Final Inspection By Date U SPERMIT-Approved by Character of Soil to Depth Ft: ® Pit/Sump Soil Character: COMMENTS 11,A �� w-0 AbLo07 -- --- - - --- - - - 1-- PE SC Received hec *AMOUnt Permit/ Code INFO B Cash Date Service Request# Invoice# Permit ID# 4-z1L It:7o 5R00$ I a 4 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18