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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 NOWHIEFUNDABLE PERMIT (,ALL ((ZUy) YDJ-/Dy/ FUR (NSPEGTIUNS tXPIRES II YEAR FROM DATE ISSUE JOB ADDRESS 3zS-Zi S- IKos-' �-C1- CRY/zIPr� TF-�G� f 0O`T CROSS STREET s -r - 2T . q3. 3 APN 2SS7 Z4 PARCEL SIZE 31-33 A. OWNER NAME LA-, E -LL PHONE 4-1( 5-1i-) OWNER ADDRESS C/0CA1LL 1VI PntkA LTiS L0' $LEhJETTCITY/STATE/ZIP T 9A( -y C -Pt 9s--304 CONTRACTOR (-W I JJO �I- ED C-ENJYY�ENI V -1(Z A L_ PHONE �I � - O-1 ''TS CONTRACTOR ADDRESS D-1 vu • U Pc K- ST ' CRY/STATE/LIP LOD (-7 CA �I ZLI D LICENSE [10C-42❑ 0C-36 OTHER C 6 (S NUMBER I I - EXPIRATION DATE q- 7 V - ZZ'" FR 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/ALTERNATIVE C) REPLACEMENT I.] OUT -OF -SERVICE SEPTIC SYSTEM IJ DESTRUCTION INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: .1 ❑ SEPTIC TANK TYPE/MFG CAPACITY gal # OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS d DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) ❑ LEACH LINES I-] LEACHING CHAMBERS # OF LINES LENGTH OF LINES ft PARCEL "2" 3s.uo ncxEls, K--_ "1 DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ FILTER BED WIDTH ft LENGTH N99'b'14'E 3113.4a' "DESIGNATED REMAINDER" 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 DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE 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. MINIMUM 48 HOUR ADVANCE NOTICE R UIR D FOR INSPECTIONS - PL A E CALL951-769 SIGNED TITLE DATE Al 1/4 SECiXIN UNE \ HAVMM lMOLY]LLC Al500'40']Ow u: 191)AR' sac4o'szw ,� xF _, i 1 Application Accepted By " Final Inspection By Character of Soil to Depth of 3 Ft: COMMENTS It IK Ld U1 se (SEC oaE 'B) sar3s'mw cuss' I =�7 zss-loo-za R� NAVIAM FnNttY LLC I I i DEPARTMENT USE ON LY Date O 1 i % Area q� Employee ID# Date ❑ SPECIAL PERMIT -Approved by Pit/Sump Soil Character: PE SC Received Check#/ Amount to PprmiU Invoice# PermitlD# Code INFO ash Remitted Service Re u st # as 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18 AYMENT ECEIVE® 'T 18 2021 OAQUIN COUNTY VIRONMENTAL TH DEPARTMENT Y+ � J uo.00' SaY40']0 PARCEL "2" 3s.uo ncxEls, K--_ "1 RF z�' PARCEL 310.00' �3 �� z+s harts (NouEsrto_ ssrb'szw (sEE oETna •n) 1g law, N99'b'14'E 3113.4a' "DESIGNATED REMAINDER" N-m'0"N 31." a Es 0 -25� PARCEL "3" mau' SaV]0'11'E xF _, i 1 Application Accepted By " Final Inspection By Character of Soil to Depth of 3 Ft: COMMENTS It IK Ld U1 se (SEC oaE 'B) sar3s'mw cuss' I =�7 zss-loo-za R� NAVIAM FnNttY LLC I I i DEPARTMENT USE ON LY Date O 1 i % Area q� Employee ID# Date ❑ SPECIAL PERMIT -Approved by Pit/Sump Soil Character: PE SC Received Check#/ Amount to PprmiU Invoice# PermitlD# Code INFO ash Remitted Service Re u st # as 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18 AYMENT ECEIVE® 'T 18 2021 OAQUIN COUNTY VIRONMENTAL TH DEPARTMENT