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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) 9537 7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS ¶744D 7 zAhl 7/L4)±e&crryfzip szzo CROSS STREET gih 64/c, ZAJ AFN 00 73/ D S PARCEL SIZE OWNER NAME /(.L1/ PA ilhpS OWNER ADDRESS ect 3,„ tui -I- CONTRACTOR 67k4/ CONTRACTOR ADDRESS 1 7,t. LICENSE 14,42 Li C-36 OTHER NUMBER 501.5./K-EXPIRA11ON DATE (3747 PHONE -6 5-7 V crryesTATF_Izip kyi po gç 3 PHONE 34 --5--e"e' crnisrATEJzip WATER TABLE DEPTH: i 30 LI PERC TEST # BUILDING PERMIT # (.) ) (40 LAND USE APPLICATION # ft GEOGRAPHICAL INFORMATION: Coordinates X TYPE OF WORK: NEW INSTALLATION X. REPLACEMENT REPAIR/ADDITION OUT-OF-SERVICE SEP11C SYSTEM ENGINEER DESIGNED/ALTERNATIVE DESTRUCTION INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS: g- RESIDENCE U COMMERCIAL NUMBER OF BEDROOMS: Li OTHER NUMBER OF EMPLOYEES: AIL SEPTIC TANK TYPE/MFG GREASE TRAP TYPE/MFG DISTANCE TO NEAREST: WELL LIFT STATION SIZE TYPE OF PUMP CAPACITY /ZXO gal 4/ OF COMPARTMENTS Z. CAPACITY gal 4/ CE COMPARTMENTS ft PROPERTY LINE ft 0 PKG TX PLANT 0 SAND OIL SEPARATOR (ENCLOSED SYSTEM) ft FOUNDATION ZeD 51-- LEACH LINES LEACHING CHAMBERS DISTANCE TO NEAREST FILTER BED WIDTH DISTANCE TO NEAREST CI MOUNDED WIDTH DISTANCE To NEAREST ID SUMPS WIDTH DISTANCE TO NEAREST DISPOSAL PONDS WIDTH SEEPAGE PITS NUMBER 3 DISTANCE TO NEAREST DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft WELL " ft FOUNDATION ft PROPERTY LINE SZ) ft WIDTH ft DEPTH ,,,2 5 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. 72y MINI ...11.28 HOU ____C___E NOTICE REQUIRED FOR INSPECTIO)VS6-22SE CALL (209)953-7697 SIGNED - TITLE r_....0-077.. DATE ft LENGTH WELL ft LENGTH WELL ft FOUNDATION ft PROPERTY LINE ft LENGTH ft DEPTH WELL ft FOUNDATION ft PROPERTY LINE ft DEPTH # OF LINES 3 LENGTH OF LINES 5"5" WELL 100 ft FOUNDATION 75- ft PROPERTY LINE SO' ft DEPTH ft FOUNDATION ft PROPERTY LINE ft LENGTH ft DEPTH ft ft ft ft ft ft ft ft ft "ik Joz Application Accepted Final Inspection By Character of Soil to Depth of 3 Ft: COMMENTS JsJE, F 1Z • -7; DT pEPARTMENT USE ONLY Date I 1 k //) Area Li a I triliSloyCfriPt Date Li /ger2-0z4 Li SPECIAL PERMIT- ApproveAf0. ' r PJ 4 eITs 'H/ fl y' 70U/id', It/Sump Soil Character: 4/47 PE Code SC INFO Received By Ch., lit-) Amount Remitted Date Permit/ Service Request # Invoice # Permit ID# Cash LP/1 117 2;1"(i2.0 `VS- ? LI (I 019- ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 42-01 4/14/18