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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT r SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 95202-(209)468-3420 NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FRQMTE ISSUED JOB ADDRESS Z�T� 7 N /-A Ew 00PE RD' CITY/ZIP ti CROSS STREET iij0 L)ELL APN col -LIo-33 PARCELSVE SO A-r C t, �1 0 OWNER NAME A L E.0 — "PAirtAF C H E-P PHONE Ctf(P 7-S-(P40 tp /7 �L G ,- L,. OWNER ADDRESS P'p' ��} (0T Q CITYISTATE/ZIP I r7 VRN1 CONTRACTOR LIJE p1''!t�- G-EOENVIr¢o�►wt��.r-rnL PHONE u`I" 3(o er—^3? S- CONTRACTOR ADDRESS ()? N�• y�' S'r CITY/STATE/ZIP L-y�( ' LICENSE C.42 '•C.36 OTHER NUMBER EXPIRATION DATE I WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y r PERC TEST # Z BUILDING PERMIT# LAND USE APPLICATION# PA,-I V-0 D L 74P TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT DESTRUCTION INSTALLATION WILL SERVE: RESIDENCE COMMERCIAL OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS DISTANCE TO NEAREST: WELL fl FOUNDATION ft PROPERTY LINE R ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) ❑ LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES It DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LINE R ❑ FILTER BED WIDTH R LENGTH R DEPTH R DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE R ❑ MOUNDED WIDTH ft LENGTH R DEPTH ft DISTANCE TO NEAREST WELT R FOUNDATION R PROPERTY LINE ft ❑ SUMPS WIDTH _it LENGTH it DEPTH ft DISTANCE To NEAREST WELLft FOUNDATION ft PROPERTY LINE ft ❑ DISPOSAL PONDS WIDTH It LENGTH ft DEPTH fl DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE R ❑ SEEPAGE PITS NUMBER WIDTH R DEPTH ft DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LINE fl 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. MINIMU:34 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS PLEASE CALL(209)953-7697 SIGNED TITLE ao"rJ I(�N i DATE f- 1 \ .J �\ ' \ -AUI IAII I I REC MENTI I EIV \ I AN 1 2018 -.. JOAQUIN OA • ... _ - ..... VI�OryIryCOUNTY > MENTI DEPARTMENT SE O Y H�EPARTMEN Application Accepted B to 0 Area Employee ID# [— r Final Inspection By9oILFt - QAte r SPECIAL P MIT-Approved byCharacter of Soil to Dept ,'/ Pit/Sump Soil Character: [ COMMENTS (i i I•-\ l i' ;a-n �_� r� T? 5L, rn. r;!'•_� 16 PE SC Received hoc Amount Date Perm1U Invoice# Permit ID# Code INFO B as RemittedService Ro uest# 7,Z t vlo I� Sra� SEI 42.Ot ONSITE WASTEWATER TRTMNT SYSTEM PERMIT