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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1866 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)4683420 NON-REFUNDABLE PERMITCALL(209)y9553-7697FoRINSPECT/ONS EXPIRES 1 YEAR FROM DATE ISSUED +t JOB ADDRESS �-�-� + ��Ce L+ W 9 E. (�r1�� CITY/ZIP L-O D( 2-40 p {�y y CROSS STREET L L.EV C- ^--rpS APN Q(0,-0-4U'-D 1 PARCEL SIZES (Aj�L7V� OWNER NAME7✓�W��F/�rlt�� PHONE Lt O-! P.o. J OWNER ADDRESS 1-•o• VSOS CITY/STATE/ZIP CC.�-t�t--II S CA Cy /SZZ1 CONTRACTOR L J O P^r7K-- (,-�ot�.l�1 eoru ryt Ei.,i�`- PHONE 3�i 1 031 CONTRACTOR ADDRESS 4O / QS� CITY/STATE/ZIPL--O�t C- �� -L- C) LICENSE C42 ..'; C36 OTHER P NUMBER P I EXPIRATION DATE Lf//2jk J�U WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# A- I U7 3 TYPE OF WORK: NEW INSTALLATION REPAWADDITION ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM 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 ft FOUNDATION ft PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) ❑ LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft DISTANCE To NEAREST WELL ft FOUNDATION ft PROPERTY LINE It ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ MOUNDED WIDTH ft LENGTH it DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ SUMPS WIDTH ft LENGTH It DEPTH ft DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft ❑ DISPOSAL PONDS WIDTH ft LENGTH R DEPTH It DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE ft ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft 1 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. INSPECTIONS PLEASE CALL WEI)953-769 - SIGNED TITLE PIS-'CJ v>162 DATE -f- i ,F- , NT u� o Application Accepted By L L' Date J;i) Area f E4" Final Inspection By Date SPECIAL PERMIT-Approve DE Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS PE SC Received Check#/ I Amount Date Permit/ Invoice# Permit ID# Code INFO B Remitted Service Request# 'Idda 76 0 1-2+USilt 3 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18