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e l ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 NON-REFUNDABLE PERMIT) (J / LG`/ALL LUy ybJ-/bY1 FOR INSPECTIONS / I' ,/tx N/IKtS I T LAK 1-KUM LJA I t 1"Ut1 JOB ADDRESS /3%,.F� /`/Y �' �U/C l�,�` /J CITYIZIP /'ems yel-i (X CROSS STREET .� G!L l`-' �0wl� IZ*D0'/lf APN O ' 3 0 0 ) oI PARCEL SIZE OWNER NAME �M � `qr V ' PHONE ) OWNER ADDRESSC4" r CITY/STATE/ZIP CONTRACTOR �MI/(L/,(�"/ /n11.7 -C f� PHONE -20'? CONTRACTOR ADDRESS -77 / � ��/'�G�'+ �� /�� CITY/STATE/ZIP LICENSE LXG-42 u. C-36 OTHER NUMBER S EXPIRATION DATE WATER TABLE DEPTH: 110- ft GEOGRAPHICAL INFORMATION: Coordinates X Y C PERC TEST # BUILDING PERMIT # I; At a F j / LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED /ALTERNATIVE REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: C RESIDENCE L COMMERCIAL C OTHER NUMBER OF LIVING UNITS://,� NUMBER OF BEDROOMS: `�d NUMBER OF EMPLOYEES: SEPTIC TANK TYPE/MFG (0/I1 C CAPACITY / `� ��/ gal # OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS i DISTANCE TO NEAREST: WELL /OD ' ft FOUNDATION ft PROPERTY LINE / ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) ,1(J LEACH LINES LEACHING CHAMBERS # OF LINES / LENGTH OF LIMES Y3' LbVb& *1h, / DISTANCE TO NEAREST WELL 8 ft FOUNDATION PROPERTY LINE S (44.) 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 ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft SEEPAGE PITS DISTANCE TO NREST WELL [� ' NUMBER WIDTH 7 ft FOUNDATION ft ft PROPERTY LINE DEPTH d!s- , ft ft DISTANCE TO NEAREST WELL /'S—O ' ft FOUNDATION yo I ft PROPERTY LINE .S 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. % DEPARTMENT US ONLY Application Accepted By �� `- Date Area L �/ G^ Employee ID#A_ Final Inspection By d Date L SPECIAL PERMIT -Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS SPcon-j I!:�1� Nwei�lr�6, j,pr rail �a��J� iJ�i 5Z)i I Gr,yE%P PE SC Code INFO 9d ) ) H% Jlche< uY ; ,Dc k: cit Received Check Amount Permit/ By Remitted Dat _Service Regi r #I Invoice # I Permit ID# 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/16 fi