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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 NON-REFUNDABLE Cy 17 �C.A,�L�L (20`9 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS _ 101 tR 1 ✓ S • SE c/ rir� P-6 . CITY/ZIP C;r-AL_0n1 9J 32-0 /� H CROSS STREET CP-AI APN Lg{� —llv — 2-9 3- +1 Ar OWNER SIZE �y OWNER NAME � -L7-, r C� �7 PHONE .1 a V- 2- 1,51 Lf OWNER ADDRESS r I -t l T� s' SE x!�N r�•b • CITY/STATE/ZIP BSc fYL-7-yN, C fl 9S-32-0 y CONTRACTOR LICE O PVK GEO F-I. V I(ZO rV rn Eh/7 A PHONE 3 t:s`I` 03-7 CONTRACTOR ADDRESS 4o-1 w ,'F --I _ CITY/STATEIZIP L-OD LICENSE U; C-42 OOC-36 OTHER CE C- 44 —NUMBER ZI S� EXPIRATION DATE -T(7-1-2- WATER TABLE DEPTH: it GEOGRAPHICAL INFORMATION: Coordinates X Y PERC TEST # I BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE I REPLACEMENT f7 OUT-OF-SERVICE SEPTIC SYSTEM LI DESTRUCTION INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPE/MFG CAPACITY 931 #OF COMPARTMENTS ❑ GREASETRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS DISTANCE TO NEAREST: WELL It FOUNDATION It PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED. SYSTEM)) _. -._.._.. ------....__._...-_.... -_.-_ . ................. ..._._.._.. ....._......----.......- P 13 LEACH LINES I 1 LEACHING CHAMBERS #OF LINES LENGTH OF LINES A ��`' DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE_ /1'f� / ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft �/pe6 DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE ft" 'sb ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ,t ft(n/ �O^� DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE ❑ SUMPS WIDTH It LENGTH ft DEPTH Ely ftI COU DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE L]-{-J� '1(tJ Nrq/V IY ❑ DISPOSAL PONDS WIDTH ft LENGTH R DEPTH T TMENT DISTANCE TO NEAREST WELL it FOUNDATION It PROPERTY LINE ft ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH It DISTANCE TO NEAREST WELL It 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 4HQUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209)953-7697 SIGNED _ TITLE P12 9j. CY� . DATE to -2-1 -L 1 t Y ELI I I I IT' DEPARTMENTUSEONLY r Application Accepted By � 1 Date I 1 v 1 Area Employee ID# _ Final Inspection By Date ❑ SPECIAL PERMIT-Approved by Character of Soil to Depth of 3 Ft:_-- _ Pit/Sump Soil Character: COMMENTS PE SC Received Check#/ Amount Date Permit/ Invoice# Permit ID# Code INFO — Remitted Service Re uest# 42-01 4/14/18 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT