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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN J6AQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 NON-REFUNDABLE PERMIT CALL (209) 953-7697 FOR INSPECTIONS �M EXPIRES 1 YEAR FROM %DATE ISSUE[ JOB ADDRESS �) O -"l �,n!G� ce' ✓4 1 -�Q CITY/ZIP V � lob t-'Gf4 CROSS STREET /Ef �c( �[ ✓ 6Y*) %� Cc`} Ci APN (%�O'L ` LfC, -' PARCEL SIZE OWNER NAME `1'Q (-I f -S. ✓ ! �-✓� t}'� �*Q� F� PHONE OWNER ADDRESS CITY/STATE/ZIP CONTRACTOR YY L (� r�U%%,,��ld� ��a PHONE ? CONTRACTOR ADDRESS �O /JOXi / CITY/STATE/ZIP LICENSE ❑❑C-42 ❑CIC -36 OTHER Y'J ^ NUMBER&b n s�lEXPIRATION DATE{CL'= WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # TYPE OF WORK: [/ NEW INSTALLATION n REPAIRIADDITION ❑ ENGINEER DESIGNED /ALTERNATIVE ❑ REPLACEMENT 0 OUT -OF -SERVICE SEPTIC SYSTEM ❑ DESTRUCTION INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: I NUMBER OF BEDROOMS: 3 NUMBER OF EMPLOYEES: ®' SEPTIC TANK TYPE/MFGlCAPACITY I h gal # OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS DISTANCE TO NEAREST: WELL �Z�a fi ft FOUNDATION I is , ft PROPERTY LINE SUI ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) LEACH LINES ❑ LEACHING CHAMBERS # OF LINES 3 LENGTH OF LINES 0 ft DISTANCE TO NEAREST WELL O 1 ft FOUNDATION �� ft PROPERTY LINE �t7 ft ❑ FILTER BED WIDTH ft LENGTH ft DEPTH 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 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL 209 953-7697 SIGNED TITLE vow �GG-7p (� DATE ZI Application Accepted By -7e Final Inspection By Character of Soil to Depth of 3 COMMENTS & !J✓or,0, S PARTME 9 Dates Date p Soil C Area Employee ID# ❑ SPECIAL PERMIT -Approved by PE Code DISTANCE TO NEAREST WELL ft FOUNDATION 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 WIDTH ft DEPTH ft DISTANCE TO NEAREST WELL ft 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 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL 209 953-7697 SIGNED TITLE vow �GG-7p (� DATE ZI Application Accepted By -7e Final Inspection By Character of Soil to Depth of 3 COMMENTS & !J✓or,0, S PARTME 9 Dates Date p Soil C Area Employee ID# ❑ SPECIAL PERMIT -Approved by PE Code SC INFO Received By Oeck#Y Amount Remitted Date Permit/ Service Request # Invoice # Permit ID# 42-1 -uq 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18