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r ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA95205-(209)486-3420 NON-REFUNDABLE PERMIT ++ CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS 1 1 CROSS STREET \ "GI(iL. - APN 0,,d SJ yPARCEL SIZE '�•�� C OWNER NAME LLX.1 ) '} PHONE OWNER ADDRESS `^�eI �/]' , �F }IN}11��jt 11 Lr }j(' Crit/STATEIZJPP L.XO^/) CONTRACTOR PHONE ` 33t 1{�?6 CONTRACTOR ADDRESS �l`lIS` TCITY/STATE/LP r/ ( LICENSE _i C-42 C-36 OTHER NUMBER SI 15-7 EXPIRATION DATE WATER TABLE DEPTH: I ft GEOGRAPHICAL INFORMATION: Coordinates X Y l` 1 ❑ PERC TEST # BUILDING PERMIT#__ LAND USE APPLICATION# TYPE OF WORK: NEW INSTALLATION - /REPAIRIADDITION ENGINEER DESIGNED 7ERNA7NE REPLACEMENT 111 > -ICK, OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION 7(,:;{ C INSTALLATION WILL SERVE: _ RESIDENCE COMMERCIAL OTHER �J NUMBER OF LNING UNITS: �j NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: 1G SEPTIC TANK TYPE/MFG 7 q CAPACITY ,1 rte.�9a1 #OF COMPARTMENTS (i ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS DISTANCE TO NEAREST: WELL 1_T_J ft FOUNDATION ft PROPERTY LINE 5 } ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) r LEACH LINES X LEACHING CHAMBERS 1111"1 tYA•1,-(S #OF LINES LENGTH OF LINES ft DISTANCE TO NEAREST WELL�;, D ft FOUNDATION IJr ft PROPERTY LINE Sr 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 ❑ SUMP$ WIDTH It LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft / DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ,011J SEEPAGE PITS NUMBER WIDTH 3 1 ft DEPTH 2r-�� ft pq DISTANCE TO NEAREST WELL It FOUNDATION I f ft PROPERTY LINE J fl L 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. v C� 4 DV N N I E RED F INSPECTIONS ESE AL 2 953-7697 �j� 0 4O SIGNED TITLE L r - DATE Z `� 20 NV R 20 Ty�FpgRT��NTy H,- ------------------------------ -------------------------------------------- ----------------------- ----------------------- ----------------------- 11 MENT 7 DEPARTMENT USE& ONLY Application Accepted PV ,rfV L-- Date ('I q4,? Area -1 Ti Employee ID# _ Final Inspection By Date {1.-_ SPECIAL PERMIT-Approved by Character of Soil to Depth of 3 t: Pit/Sump Soil Character: CO M NTS SyStP,- rP X exi-:h% jy. '6111 �i ?,1 ` ) 7 ,n I PE SC Received Check#/ Amount Permit/ Code INFO Cash Remitted ate Se ice R uest# Invoice# Permit ID# wary >>� 42-01 4/14/18 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT -//�//�