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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-KEFUNDABLE PERMIT GALL (ZU9) 953-1691 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUE/ JOB ADDRESS �' v ^ _ CITY/ZIP Ar-gpn we, CROSS STREET / IC/4-0E 7!26 e4/ -7 �f APN / d p 0 J Lj PARCEL SIZE t-� OWNER NAME /� -P(/ez1a NJ 5- '- A("Ia TT 7 yO(� ^ I� ��(/I 1f�ZPvP(�O P r J 3 '1' / PHONE OWNER ADDRESS l M CITY/STATE/ZIP ft LENGTH CONTRACTOR %s� / [/ �/,, /f/ Ly,0/yg1 Y�^d�/j�Jf / 9 PHONE `—�`f / �JLV�/�n� CONTRACTOR ADDRESS / I ' (_ rot(✓T eft, �,y// 1464-0 0 �� CITY/STATE/ZIP �/�sda /7 G^ I -S/VCZ �V / l4 9 jdd 9 LICENSE ❑K-42 ECIC -36 OTHER NUMBER S .S -EXPIRATION DATE Z?_ _? / •-- L-2-? WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION F1 REPAIR/ADDITION Cl ENGINEER DESIGNED /ALTERNATIVE ❑ REPLACEMENT ❑ OUT -OF -SERVICE SEPTIC SYSTEM ❑ DESTRUCTION INSTALLATION WILL SERVE: ❑ RESIDENCE XCOMMERCIAt ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: 1 % NUMBER OF EMPLOYEES:�I ,i9� SEPTIC TANK TYPE/MFG ❑ GREASE TRAP TYPE/MFG L CAPACITY !ao© gal # OF COMPARTMENTS_ A• CAPACITY gal # OF COMPARTMENTS DISTANCE TO NEAREST: WELL O ft FOUNDATION .30 ft PROPERTY LINE //0 00 ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) X! LEACH LINES ❑ LEACHING CHAMBERS # OF LINES Amount Remitted LENGTH OF LINES ft \ Permit ID# DISTANCE TO NEAREST WELL I ' ft FOUNDATION O ! ft PROPERTY LINE 0 ft ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDAI ION 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 ft 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 P WIDTH L4 / -ftp DEPTH �� / ft DISTANCE TO NEAREST WELL /60 � ft FOUNDATION :5-6 Z 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. IVIIIY11YIUM YO "L/UrN HL/ VH/YVC /YV I1l..0 ICC U1ICCL.1 I-Vrx IIYJr-Cli I luivo L/rLCHJC IiHLL LVy UU,)-/ UV I SIGNED TITLE GvvJ�i'�C[jG►l DATE l —4121 % I DEPARTMENT USE ONLY Ap��i ation'Accepted By �- �`- v �- Date ) ? ,? Area -t -/ Employee ID# F f FirSaY ctt�n By rl �t k4=(; k , Date l µ l ZZ ❑ SPECIAL PERMIT -Approved by Character of Soil to Depth of 3 Ft: �— Pit/Sump Soil Character: COMMENTS CoMyrf-rei*J 5y5gem -Cc Ar, ,, ih afr,,e., cnd AU11 rps4-.om. e r SS LS 6 ? I ,Mf") Valle jid +� glen® �rn,f ax qd "b es eine` rxt/8'ptts PE Code SC INFO Received By C Check ash Amount Remitted Da Permit/ Service Request # Invoice # Permit ID# Wait ai-0 2 G -�$ 1 2 mi 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18 T