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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-REFUNDABLE PERMIT /^ 11 CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS I11D�?5-0 L C_• /'tem/LV LN - CITY/ZIP �-V�I .�Z O CROSS STREET r� I o� 1 APN OU 3^ Oa V-��•�- m A /` �i.p PARCEL SIZE Z�•G O OWNER NAME FW�1 0 L-A G�'\�—a...l,A PHONE`v(/�(7j &-13 "&2 F I� ��G y OWNER ADDRESS _ 21 Lf E• 1�IL�y S I - CITY/STATE/ZIP L-07 I C e-) q/ 240 CONTRACTOR L I V t 0GN e0 LVI RzrTi0 IUMI l,J-TA L_ PHONE 3 te9-03-1 y CONTRACTOR ADDRESS 4D� w' 0A `— .mo— ` CITY/STATE/ZIP L-Q� � I ``�� C ' 01 Z�FO LICENSE 1-ii.'�C-42 ❑0C-36 OTHER C C.V NUMBER 215-1 EXPIRATION DATE 4—3 0_ L q WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y PERC TEST # L BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: _ NEW INSTALLATION REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT i. OUT-OF-SERVICE SEPTIC SYSTEM LI DESTRUCTION INSTALLATION WILL SERVE: ❑ RESIDENCE D COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS Ll GREASETRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft L3 LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) ❑ LEACH LINES l LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft 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 It ❑ DISPOSAL PONDS WIDTH It 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 46 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS PLEASE CALL(209)953-7697 SIGNED --- .. TITLE DATE --DAV MENT CEIVE® ---------------------------------- 12 2022 ---------- -------- 4-(# OAQUIN COUNTY VIRONMENTAL TH DEPARTMENT ----------------- I DEPARTMENTUSE ONLY Application Accepted By / Date rea Employee ID#� Final Inspection By Date ❑ SPECIAL P MIT-Approved by Character of Soil to Depth of 3 Ft:_ i� Pit/Sump Soil Character: COMMENTS PE SC Received Check#/ Amount Permit/ de INFO B Cash Remitted Dat Service Re ue t# Invoice# Permit ID# 42-01 4/14/18 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT