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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JUAUUIN COUN 1 Y ENVIRONMENTAL HEALTH DEPARTMENT 1568 E. HAZELTON AVENUE - STOCKTON CA 95205 -(209) 468-3420 NUN-r[tFUNUAt5L/t� r'tRMll JOB ADDRESS CROSS STREET OWNER NAME OWNER ADDRESS yJJ-TD`JT FUfY1N51'ECT10N5 tXPIRE3 I YEAR FROM UATE ISSUEI Crrr�l]rZn `' APN O � 1! y) U PARCEL SIZE J' -��I PHONE 2Lrl • 561 tL wt I CONTRACTOR Lb&2 + /r (�/GtQr14 L. PHONE ZQCJ':� I--�(�-91L CONTRACTOR ADDRESS 33 I'�IJ/H�+�K 11 CITY13TATlJAP LZ% I CA "-524C) LICENSE C-42 C36 OTNFR A NIIMRFRS 1151 EXPIRAToNDATE ZD7� WATER TABLE DEPTH: 7 0 C' "J R GEOGRAPHICAL INFORMATION: Coordinates X Y I HEREBY GE RTiFY 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 SE ONLY Application AccepteuLe41: �r2 L Date �1 I Area (% Employee ID# Final lnsped—,ByA-- I \— Date --� SPECIAL PERMIT - Approyedby Character of Soil to t: It/Sump Soil Character: COMMENTS �hflj 1)"Jes f�? ferle'lil'. 1t, '�-Jells 1► (.) EHL) : Pts iC-45 1. :ii % ' '�G �. PE I SC I Received Ch.W Ant Permit/ _ A moupate i __ _ IInvoice # I Permit ID# 42-01 4114111 I)I XI � � s T L I // </ Zv Q.JE WASTEWATER TRTMNT SYSTEM PERMIT YMENT CEIVED 17 2021 �AOUIN COUNTY 11RONMENTAL rH DEPARTMLNI PERC TEST # I BUILDING PERMIT # LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLAT1DN V REPAIRIADDIT10N ENGIMFFR DFsrNED IALTFRNATNE REPLACEMENT OUT -OF -SERVICE SEPTK: SYSTEM DESTRUCTION INSTALLATION WILL SERVE: RE1IOENCE ..: COMMERCIAL - OTHER NUMtlEK UH LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPE'MFG CAPACITY Dal #OF GOMPARTNFNTS ❑ GREASE TRAP TYPE'MFG CAPACITY (gal # OF COMPARTMENTS DISTANCE TO NEAREST: WELL Il FOUNDATION it PROPERTY LINE fl ❑ LIFT STATION SIZE TYPE OF PUMP O PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) 1d LEACH LINES LEACHING CHAMBERS � , a�OYS #uf= LINES LENGTH OF LIN=S Lob' ft DISTANCE TD NEAREST WELL N 4v R FOUNCATION Il PROPERTY JNE ft ❑ FILTER BED WIDTH ft LENGTH _ ft DEPTH ft DISTANCE TO NEAREST WELL It FOUNCAIION fl PROPERTY JNE ft ❑ MOUNDED WIDTH 11 LENGTH It DEPTH ft DISTANCE TO NEAREST WELL It FOUNCAMON ft PROPERTY JNE It ❑ SUMPS WIOIH R LENGTH ft DEPTH f1 DISTANCE TO NEAREST WR.I. ft FOUNDATION It PROPERTY -INE fl ❑ DISPOSAL PONDS WIDTH ft LENGTH t DEPTH ft DISTANCE TO NEAREST WELL ft FOUNCATION ft PROPERTY JNE Ft SEEPAGE PITS NUMBER Z— WIDTH 3L,II It DEPTH Z,51___ R DISTANCE TO NEAREST WELI 1\ IFt R FOUNCATION 10,T, ft PROPERTY JNE i ft I HEREBY GE RTiFY 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 SE ONLY Application AccepteuLe41: �r2 L Date �1 I Area (% Employee ID# Final lnsped—,ByA-- I \— Date --� SPECIAL PERMIT - Approyedby Character of Soil to t: It/Sump Soil Character: COMMENTS �hflj 1)"Jes f�? ferle'lil'. 1t, '�-Jells 1► (.) EHL) : Pts iC-45 1. :ii % ' '�G �. PE I SC I Received Ch.W Ant Permit/ _ A moupate i __ _ IInvoice # I Permit ID# 42-01 4114111 I)I XI � � s T L I // </ Zv Q.JE WASTEWATER TRTMNT SYSTEM PERMIT YMENT CEIVED 17 2021 �AOUIN COUNTY 11RONMENTAL rH DEPARTMLNI