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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE -STOCKTON CA95205 - (209) 468.3420 NON-KEFUNUABLE tXPIRES l YEAR FROM UATE ISSUEI JOB ADDRESS 'V Lay jZe,7C1C1 CITY/LPz,r=cc, 6-y CROSS STREET _ T% !//C✓ /��(.) luz APN O✓ Iy S PARCEL SIZE y 8" OWNER NAME M 1 �(= I1Y1 IS l' 3 �/If i1C�i/� PHONE OWNER ADDRESS(1111-e CITYISTATE/ZIP CONTRACTOR Le "i VL{ y / u� /1,/� 4 y�Ci �J (E/� PHONE //�6✓ r CONTRACTOR ��wA(((D'''D��_RESS CITYISTATE/ZIP `4- � � Jr LICENSE �G-4Y 1-, C36 OTHER NUMBER &XPIRATON DATE 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. J DEPARTMENT US ONLY Application Accepted—�G.�� Date ' 7 ' Area i LL Employee ID#-� Final Inspection By 7Z y.%� Date y� SPECIAL PERMIT -.Approved by Character of Soil to pth of 3 Ft: �— Pit/Sump Soil Character: COMMENTS :Scu r-iJ SEK %/er PE SC Received Amount Permit' PERC TEST # BUILDING PERMIT'# If / LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION REPNRIADDITION ENGINEER DESIGNED /ALTERNATIVE / R PROPERTY LINE_ ft REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: RESIDENCE COMMERCIAL OTHER NUMBER OF LIVING UNITS: I NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: SEPTIC TANK TYPE/MFG 6I I L 7' CAPACITY gal # OF COMPARTMENTS ❑ GREASE TRAP TYPEIMFG CAPACITY gal # OF COMPARTMENTS 'DISTANCE TO NEAREST WELL It FOUNDATION DISTANCE TO NEAREST: WELL /��C c ft FOUNDATION �J / ft PROPERTY LINE C(,� / R ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) 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. J DEPARTMENT US ONLY Application Accepted—�G.�� Date ' 7 ' Area i LL Employee ID#-� Final Inspection By 7Z y.%� Date y� SPECIAL PERMIT -.Approved by Character of Soil to pth of 3 Ft: �— Pit/Sump Soil Character: COMMENTS :Scu r-iJ SEK %/er PE SC Received Amount Permit' LEACH LINES LEACHING CHAMBERS #OFLINESl .�! LENGTH OF LINES SS ft DISTANCE TO NEAREST WELL ft FOUNDATION / R PROPERTY LINE_ ft ❑ FILTER BED WIDTH It LENGTH R DEPTH ft DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE ft ❑ MOUNDED WIDTH ft LENGTH R DEPTH ft 'DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft ❑ SUMPS WIDTH It LENGTH ft DEPTH It DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LINE ft ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft DISTANCE T NEAREST WELL FOUNDATION ft PROPERTY LINE ft SEEPAGE PITS NUMBER_ /It WIDTH /Z It DEPTH �J ` ft 1 DISTANCE TO NEAREST WELL R FOUNDATION / ft PROPERTY UNE / C It 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. J DEPARTMENT US ONLY Application Accepted—�G.�� Date ' 7 ' Area i LL Employee ID#-� Final Inspection By 7Z y.%� Date y� SPECIAL PERMIT -.Approved by Character of Soil to pth of 3 Ft: �— Pit/Sump Soil Character: COMMENTS :Scu r-iJ SEK %/er PE SC Received Amount Permit' Invoice # Permit IDN Code INFO Remitted i Service Request # 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18 Ir