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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 209 953-7697 FORINSPECT/ONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS `l�7 /TI�/ (�i- /� CITY/ZIP V Q Zz m CROSS STREET 1,/ l7�CyJ��-� �G-'L APN��7� � � PARCEL SIZE p OWNER NAME�1 , N,JrJ/V PHONE 7� 77'/ —7- �,�5/ J OWNER ADDRESS CITY/STATE/ZIP CONTRACTOR ��'/J/yLl1L ��u �XOfi L- •/ n PHONE 7(c.•% -S�'��7// CONTRACTOR ADDRESS / 7G , 7/('44,-,w 7"r, P/L CITY/STATE/ZIP G/l1JGfv LICENSE ❑h,:C-42 ❑. C-36 OTHER NUMBER J�i�y� EXPIRATION DATE IU/,315/Z% WATER TABLE DEPTH:iM 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: Avd, RESIDENCE 1 COMMERCIAL �j I I OTHER NUMBER OF LIVING UNITS: I NUMBER OF BEDROOMS: v NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPE/MFGCAPACITY gal #OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) �1 LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES �U ft DISTANCE TO NEAREST WELL S� ft FOUNDATION ft PROPERTY LINE 70' 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 VVELL ft FOUNDATION ft PROPERTY LINE ft ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft C - SEEPAGE PITS NUMBER r WIDTH 3 ft DEPTH ft DISTANCE TO NEAREST WELL S�? ft FOUNDATION /'50 ft PROPERTY LINE Zy 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. MINIMUM 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL 209 953-7697 SIGNED TITLE DATE H O r 011PARTMENT 1JSE QrNLY Application Accepted Date tl Area Employee ID#� Final Inspection By Date I Z SPE IAL PERMIT-Approved by Character of Soil to Depth of 3 Fl. Pit/Sump Soil Character: COMMENTS ' PE SC Received heck Amount Permit/Code INFO B Cas mitted Date Service Request#IF Invoice# Permit ID# 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18 s.