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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-KEFUNDABLE PERMIT n GALL (ZU9f F.40,f-f0.4/ FOR INSPECTIONS JOB ADDRESS IS 5 5 � N• VA."�Jn11O.% RD CITYMP WY h CROSSSTREET eeeOLLrc-rt rap APNQZ J OWNERNAME TEUC tXHIKtS 7 TtAK HKLJM LJAIL ISSUt � gs220 L PARCEL SIZE / PHONE OWNER ADDRESS 5R -7E T CITY/STATEMP CONTRACTOR JS CD'VSTR'nc-rSON � JCPrrtl 'DVC, PHONE 01(') Zr-'T- 71'? -7 CONTRACTOR ADDRESS an-? jV0_LfCIro1D CAL -Ek DR # 2, CITY/STATE/IJP fj}G �Z.tr+f/,r�p /G� �IS8L8 o LICENSE 1'C-42 11 C-36 OTHER NUMBER 9Z2YSG EXPIRATIONDATE OCi/EOLI D 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 /A, V REPLACEMENT OUT -0F -SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: LP. RESIDENCE I COMMERCIAL I OTHER NUMBER OF LIVING UNITS: I NUMBER OF BEDROOMS: 3 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) fd LEACH LINES LEACHING CHAMBERS inj lir. {N # OF LINES Z LENGTH OF LINES itd` ft DISTANCE To NEAREST WELL /SDS ft FOUNDATION 50 ft PROPERTY LINE ft ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL It 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 WELL ft FOUNDATION ft PROPERTY LINE ft ❑ DISPOSAL PONDS WIDTH ft LENGTH It DEPTH fl DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft r �C SEEPAGE PITS NUMBER Y WIDTH '14 . ft DEPTH 23" ft Cr1�► 1^– Y DISTANCE TO NEAREST WELL ZDO r ft FOUNDATION /40' ft PROPERTY LINE '16' ft P EIV 4#12REBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, REC STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. MAR p 8 202ED JO HEA TH pEP E Application Accepted B Final Inspection By� Character of Soil to Depth of 3 COMMENTS Date Date TITLE DATE D 3/ E Al2/ NLY Area L SPECIAL PERMIT p Soil Character: Employee ID# Approved by PE SC Received Check#I Amount Date Permit/ Invoice # Permit ID# Code INFO Cas emitted Service Re ues 2 4 ( 4/,2! 7/��3� ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/114/ 18 fol