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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1666 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 466-3420 1'JuN-PItrUIVUAt3Lt rtHMI I (,ALL (LUN)`JJJ-f0!f1 FOR INSPECTIONS A tXPIRES 1 YEAR FROM DATE ISSUE JOBADDRESS 2 (30 N P I�(;L. I'i%• CITY/ZIP A-i.�9w eV 9S -t7-0 CROSS STREET STC OL L. 11t a APN 00-1 ZSO " �a PARCEL SIZE •1 I OWNER NAME J o rtG a s�N ��Y - PHONE 2- (d _ 1 3 (P-1 OWNER ADDRESS S6 r -AC CITY/STATE/ZIP CONTRACTOR WVC ORK 6EPfNV%e-Vr4 tF.4VTA(L PHONE 3ati-o3�s CONTRACTOR ADDRESS `FO -( W • 0 Ay- ST • CITY/STATE/ZIP `�D ( �Z(-( 0 LICENSE C-42 '..0-36 OTHER cc &I NUMBER XI 'S I EXPIRATION DATE � 'Z0 � 2-Z 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 REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: .J RESIDENCE I_I COMMERCIAL L; OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) DEPARTMENT.USE ONLY yy Application Accepted By Date 6 a' % Area 1 « Employee ID#F JZ_ Final Inspection By Date Z ❑ SPECIAL PERMIT -Approved by Character of Soil to Depth 015 Ft: Pit/Sump Soil Character: COMMENTS �i("U� v bL �sS� X34 • 6A 'h ! ►4 PE Sc Received Check#/ Amount Date Permit/ Invoice # Permit ID# _Code INFO Bv Remitted Service Request # aaa :5-,R3 I� a Its U 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18 ❑ LEACH LINES LEACHING CHAMBERS # OF LINES LENGTH OF LINES P� DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE p , ❑ FILTER BED WIDTH ft LENGTH ft DEPTH her.- er.-- DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft rC ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft� /n� DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE (�,� �- ft v 2o22 `( L3 sumps WIDTH ft LENGTH ft DEPTH �, _ M, DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE RCOdUT' , LlDISPOSAL PONDS WIDTH ft LENGTH ft DEPTH 1"o ;O /N 7 N '44 7 DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft AfT ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft 1 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 MQUR ADVANCE NOTICE RE / ED FOR INSPECTIONS - PLEASE953-769 PIeO J M V iL ' SIGNED TITLE DATE DEPARTMENT.USE ONLY yy Application Accepted By Date 6 a' % Area 1 « Employee ID#F JZ_ Final Inspection By Date Z ❑ SPECIAL PERMIT -Approved by Character of Soil to Depth 015 Ft: Pit/Sump Soil Character: COMMENTS �i("U� v bL �sS� X34 • 6A 'h ! ►4 PE Sc Received Check#/ Amount Date Permit/ Invoice # Permit ID# _Code INFO Bv Remitted Service Request # aaa :5-,R3 I� a Its U 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18