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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAOJIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPEC17ONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS 7 CITTY171P SSZzo 'r CROSS STREET Duf k..' APN l J 1�1 1 O 01 PARCEL SIZE 3o I y 3 y C OWNER NAME—Onuj _�7.OItlASSc/rn PHONE G OWNER ADDRESS Sf"r- CITY/STATE/LP 368r-ZD3/ I3Z]>L 777? CONTRACTOR r-"G //��u G PHONE_76-rr-S7>L7 CONTRACTOR ADDRESS jj CITY/STATE/ZIP LICENSE QOQ 1142 C-r3Z0 16 OTHER NUMBER r ZC ExPIRATION DATE OS/Z/ WATER TABLE DEPTH: N O SO ft GEOGRAPHICAL INFORMATION: Coordinates X Y L PERC TEST k BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: NEW INSTALLATION P` REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM _. DESTRUCTION INSTALLATION WILL SERVE: jIS RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: 19 NUMBER OF EMPLOYEES: SEPTIC TANK TYPE/MFG �s` CAPACITY A1c/ gal #OF COMPARTMENTS_ ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS i DISTANCE TO NEAREST: WELL�1G37' ft FOUNDATION /O, ft PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP O PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES ya fl DISTANCE TO NEAREST WELL I&O' ft FOUNDATION 5/O ft PROPERTY LINE O FILTER BED WIDTH ft LENGTH ft DEPTH R 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 R ❑ SUMPS WIDTH ft LENGTH it DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft {l� SEEPAGE PITS NUMBER "- WIDTH 7' ft DEPTH �S' ft DISTANCE TO NEAREST WELL J!;C>� k FOUNDATION V ft PROPERTY LINE 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. / 14JUM 48 UOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-�L SE CALL(209)953-7697 SIGNED TITLE DATE ZZ�r1-ai r D C12W 17-y 1 u/ T pip.4 4P lam A r DEPARTMENr USE ONLY r� Application Accepted By I Date 7 Area "1"I Employee ID# f_ Final Inspection By l Date C ❑ SPECIAL PERMIT-Approved by Character of Soil to De th of F. I `I Pit/Sump Soil Charafter: COMMENTS I h d em. C yls Ih ti ) s m .--i r, i I oi L` •� PE SC Received Chec Amount Date Permit/ Invoice k Permit IDk Code INFO B as Remitted Service Request k 42)Z) 42-01 0 ITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18