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a ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 KION -REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1,/YEAR FROM DATE ISSUE JOB ADDRESS I�jC� CITY/ZIPrA.W;'!o, -" CA - CROSS CROSS STREET _/ ray Niel- 1TVy( iel-/�'`//� O"?J APN 00717031 �) (� PARCEL SIZE u ' + S' OWNER NAME :jc-) 14 1 �/ S WIDTH PHONE OWNER ADDRESS DEPTH ft CITY/STATE/ZIP CONTRACTOR _/�{ tl -5-0,2 7!-��L'o 3 7& �k � �1/�/ C CONTRACTOR ADDRESS ft LENGTH CITY/STATE/ZIP .5��. LICENSE ❑Q1�42 110C-36 OTHER NUMBER EXPIRATION DATE �/— ?/ - -?-� WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X ❑ PERC TEST # BUILDING PERMIT## LAND USE APPLICATION # TYPE OF WORK: ❑ NEW INSTALLATION REPAIR/ADDITION Cl ENGINEER DE I.] REPLACEMENT IJ OUT -OF -SERVICE SEPTIC SYSTEM I DESTRUCTION Y INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: f NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPE/MFG �'� S CAPACITY ❑ GREASE TRAP TYPE/MFG CAPACITY DISTANCE TO NEAREST: WELL ft FOUNDATION ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT .TERNATIVE D gal # OF COMPARTMENTS gal # OF COMPARTMENTS ft PROPERTY LINE ft ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) 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. IVIIIVIIVIUIVI 4`0 �riLium HUVHI C IVV I IVc rxc vlrxclf rvn —-- — SIGNED TITLE�7 r,• DATE �j DEPARTMENT.USE ONLY Application Accepted By �_/`— �'� Date 3 /b o�v� Area , Employ Final Inspection By�ti� �c %JvP�l4- .�t_ Date 3, 1 ��_ ❑ SPECIAL PERMIT -Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: A14 A, COMMENTS Onde,+ffrrn+nP 1 ier Xl�f�� ljges 1/, 1eroe'1,n .�� &2 PE Code LEACH LINES 11 LEACHING CHAMBERS # OF LINES 1 r 1 LENGTH OF LINES YO / ft Date Permit/ Service Request # DISTANCE TO NEAREST WELL OC , ft FOUNDATION CV ft PROPERTY LINE TO I 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 ft ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft SEEPAGE PITS NUMBER WIDTH 3Cv /f ft DEPTH o'�S ft DISTANCE TO N REST WELL 15:2' ft FOUNDATION 420! ft PROPERTY LINE S` / 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. IVIIIVIIVIUIVI 4`0 �riLium HUVHI C IVV I IVc rxc vlrxclf rvn —-- — SIGNED TITLE�7 r,• DATE �j DEPARTMENT.USE ONLY Application Accepted By �_/`— �'� Date 3 /b o�v� Area , Employ Final Inspection By�ti� �c %JvP�l4- .�t_ Date 3, 1 ��_ ❑ SPECIAL PERMIT -Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: A14 A, COMMENTS Onde,+ffrrn+nP 1 ier Xl�f�� ljges 1/, 1eroe'1,n .�� &2 PE Code SC INFO ReceivedCheck# B Amount Remitted Date Permit/ Service Request # Invoice # Permit I a(o )Is °( *300 lV 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18 T