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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-KEFUNDABtLE F'ERMI1 / JOB ADDRESS 0 0S L CROSS STREET •16YI FOR INSPECTIONS tXPIRES 1 YEAR FROM LIATE ISSUE CITY/ZIP U rf `*Q APN 6! 3 -/ZO — 99 PARCEL SIZE Y. OWNER NAME t✓UUQ ✓l C 60141v C /1,' ✓ PHONE OWNER ADDRESS 0 /�yU �JqI l e 12 `� CITY/STATE/ZIP K%(IUcf 6 r� c��7c�j 6.� � oZS � CONTRACTOR r�u C' �I "/C PHONE �0 % ^(1✓ /`SC_� ` �/ CONTRACTOR ADDRESS ��n ��i�C CITY/STATE/ZIP /"y��/ !✓ ! LICENSE IT C-42 Eli 'C-36 OTHER NUMBER i�JEXPIRATION DATE 7-31- - �Vv' WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # TYPE OF WORK: I I NEW INSTALLATION I REPAIR/ADDITION I ENGINEER DESIGNED /ALTERNATIVE I i REPLACEMENT U OUT -OF -SERVICE SEPTIC SYSTEM 4•-�DESTRUCTION INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBS OF EMPLOYEES: i ❑ SEPTIC TANK TYPE/MFG CAPACITY gal # OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS LENGTH 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,L1 N LEACHING CHAMBERS S;,, ft ft E TO NEAREST WELL FOUNDATION ft FILTE H ft LENGTH (STANCE TO NEAREST WELL 1 E WIDTH ft LENGTH DISTANCE TO NEAREST SUM WIDTH WELL ft LENGTH DISTANCE TO NEAREST WELL x.2jj%=n DISPOSAL PONDS WIDTH ft LENGTH DISTANCE TO NEAREST WELL SEEPAGE PITS NUMBER WIDTH DISTANCE TO NEAREST WELL ft # OF LINES FOUNDATION ft FOUNDATION ft LENGTH OF LINwf1_- ft PROP No DEPTH ft PROPERT;714 DEPTH ft PROPERTY LINE DEPTH ft PROPERTY LINE DEPTH ft PROPERTY LINE DEPTH ft PROPERTY LINE 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. Application Accepted By Final Inspection By Character of Soil to Depth of 3 Ft: COMMENTS Area 41 ❑ SPE Pit/Sump Soil Character: DATE ?Z /y /� I !Z 7j_ Employee ID# AL PERMIT -Approved by PE Code ft ft FOUNDATION ft ft FOUNDATION ft ft FOUNDATION ft ft FOUNDATION ft FOUNDATION ft LENGTH OF LINwf1_- ft PROP No DEPTH ft PROPERT;714 DEPTH ft PROPERTY LINE DEPTH ft PROPERTY LINE DEPTH ft PROPERTY LINE DEPTH ft PROPERTY LINE 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. Application Accepted By Final Inspection By Character of Soil to Depth of 3 Ft: COMMENTS Area 41 ❑ SPE Pit/Sump Soil Character: DATE ?Z /y /� I !Z 7j_ Employee ID# AL PERMIT -Approved by PE Code SC Received INFO By hec Cash Amount Pternitted Date Permit/ Service Re uest # mit ID# 14S $IsAAIL_WA�L oxi 0 AL JL 0 x.2jj%=n 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18 C C A v.