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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 SCALL 209 953-7697FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED • JOB ADDRESS —CITY/ZIP C E• rT7�t"'•��y LN L-0t>1 I S-a-'i C) ELI "W4. 1 CROSS STREET r,w�Iu' 6 /� APN VU 3 ��U-2',+ PARCEL SIZE ��0 OWNER NAME I"�1 O L A G A'R-C.1 A PHONE(9.3 I)6-13 -&ZT& II y OWNER ADDRESS 2)14 E• -TU K ANA ST' CITY/STATE/ZIP L-07 9 1 C 9 Z``TD CONTRACTOR L IV t 0`(k►L GEo Lto V1 R a A)m t e r7^L_ PHONE 3&9-03-IS' 1 ` CONTRACTOR ADDRESS ` 01 W- OA I'- 31 . —CITY/STATE/ZIP L-0b 1 . C� o ] 7-q0 LICENSE [-IC-42 [1:1:I C-36 OTHER C'C(T NUMBER 7-15-1 EXPIRATION DATE -4-30- 2-14 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: 11 RESIDENCE COMMERCIAL 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 TD NEAREST: WELL ft FOUNDATION ft PROPERTY LINE It ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) ❑ LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It ❑ FILTER BED WIDTH ft LENGTH It DEPTH It DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE It ❑ MOUNDED WIDTH It LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ SUMPS WIDTH ft LENGTH It DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It ❑ DISPOSAL PONDS WIDTH It LENGTH ft DEPTH It DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ SEEPAGE PITS NUMBER WIDTH It DEPTH It DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It 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 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 SIGNED TITLE DATE YMENT CEIVED R 12 2022 OAQUIN COUNTY VIRONMENTAL HEATH DEPARTMENT DEPARTMENT USEONLY7 Application Accepted By IAJ Date rea An Employee ID# Final Inspection Byc i Li Date 7 SPECIAL AdMIT-Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS PE SC Received I Check#/ Amount Permit/de INFO B Cash Remitted Offi ServiceR ue # Invoice# Permit ID# 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18