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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 CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS V>I '�CI/TYZ`P CROSS STREET �j n "f v APN (J O�' l� )C J L, PARCEL SIZE SC Received /�,/ OWNER NAME/ PHONE OWNER ADDRESS 1 Ll G' �1' I ? C'� CTTYISTATFJZIP at Invoice # Permit ID# Service ReqLjest # �7CONTRACTOR r a C �5&-c 1 1 PHONE 4 1� I / 1 JSC CONTRACTOR ADDRESS ✓,�% % CITYISTATE/ZIP --l LICENSE /-42 —J7� C-36 OTHER NUMBER EXPIRATION DATE WATER TABLE DEPTH: �� D / 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 -0F -SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: I'C RESIDENCE COMMERCIAL ^ ` OTHER 1 NUMBER OF LIVING UNITS: / NUMBER OF BEDROOMS: J( NUMBER OF EMPLOYEES: �t S 00 SEPTIC TANK TYPE/MFG CAPACITY gal #OFCOMPARTMENTS ❑ GREASE TRAP TYPEIMFG CAPACITY gal # OF COMPARTMENTSy It J DISTANCE TO NEAREST: WELL ft FOUNDATION PROPERTY LINE 0 ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) LEACH LINES LEACHING CHAMBERS # OF LINES 21 LENGTH OF LINES ft �(�' ! C r DISTANCE TO NEAREST WELL It FOUNDATION It PROPERTY LINE _3 It ❑ FILTER BED WIDTH It LENGTH ft DEPTH It DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY UNE ft ❑ SUMPS WIDTH ft LENGTH It DEPTH ft DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY UNE ft ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft SEEPAGE PITS DISTANCE TO NA�RESIT WELL ft FOUNDATION ft PROPERTY UNE ft /, / /� ft 1 %c ' NUMBER WIDTH %'2 DEPTH t7ft �I DISTANCE TO NEAREST WELL _.(]CY-) , ft FOUNDATION �1C1 ft PROPERTY LINE Jo 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. 1, DEPARTMENT.US ONLY L, ,{ Application Accepted By �i'c �� i // Date 7 �� Area �1' /✓ C� Employee ID# rL Final Inspection By e/'c.,,t� ,'CC�� `s�_�i�%t.a7 Date / C: SPECIAL PERMIT - Approved by Character of Soil to Depth of 3FL- Pit/Sump Soil Character: COMMENTS %�o�^ reP 1 I f - ) ; �� "jl /�,P LJ t-(6, u;'7(:Y S F, r -i.. 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14118 PE SC Received Amount Per nitl Code INFO B Cash Remitted at Invoice # Permit ID# Service ReqLjest # H;)3 1 1 sYi 4 1� 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14118