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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-KEFUNDABLE PERMIT GALL(ZUY) 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUEI JOB ADDRESS /02/ I' h //� ' —CITY/ZIP J TO C k-) r15-2 CROSS STREET ('/nU/V�/ l� �� A �^� I APN lo I Q-7 ZJ �J PARCEL SIZE V 6) -7 OWNER NAME �/ 'V/,�) I l �l oY� / �f PHO'N'E 12 (/ /��2 - 6 / OWNER ADDRESS ,//ODpv/ �j W/ /�1��/ {� �/ y �/�ppf� CITYISTATEIZIP/�J/ %� cl" Vy l -ra ' �/6 CONTRACTORySQr)f'j y 1 C& ( / r k- /V/ �l 4 VY �� PHONE -2 / l �+ J �v / l CONTRACTOR ADDRESS D /✓O/` I�-�,"'�� 7 le / f'/, 2 CITY/STATE/ZIP 'r �/l�/c/-hy Ca P52-6"-/ LICENSE ❑LIC -42 ❑CIC -36 OTHER CkZi � 7 NUMBER D10 J EXPIRATION DATE / WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT # g O0 7 Cl LI LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION ❑ REPAIR/ADDITION T. ENGINEER DESIGNED /ALTERNATIVE ❑ REPLACEMENT ❑ OUT -OF -SERVICE SEPTIC SYSTEM ❑ DESTRUCTION INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: / NUMBER OF EMPLOYEES: )� SEPTICTANK TYPE/MFGC APACITY / y �D gal #OFCOMPARTMENTS 2 ❑ GREASE TRAP TYPE/MFG I CAPACITY �7 gal # OF COMPARTMENTS_ DISTANCE TO NEAREST: WELL l ft FOUNDATION 7 f ft PROPERTY LINE I t ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) T 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. SIGNED vrx TITLE DATE DEPARTMENT USE QNLY Application Accepted By 1 L Date 1Z Z q Z Area Employee ID# Ffe, V1 K Final Inspection By A Date j 6 –Z-- ❑ SPECIAL PERMIT -Approved by Character of Soil to Depth of 3 Ft: Pit/ ump Soil Character: COMMENTS SPZ- %/er 1 nk cAn�JII/' P S PE Code LEACH LINES ❑ LEACHING CHAMBERS tiV N C Check#/ Cash # OF LINES D to LENGTH OF LINES L1 ft Permit ID# DISTANCE TO NEAREST WELL 12 I ft FOUNDATION 110 ft PROPERTY LINE J 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 It DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft � SEEPAGE PITS NUMBER f07/ WIDTH & Af ft DEPTH DISTANCE TO NEAREST WELL ft ^ FOUNDATION C, ft PROPERTY LINE �� ft T 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. SIGNED vrx TITLE DATE DEPARTMENT USE QNLY Application Accepted By 1 L Date 1Z Z q Z Area Employee ID# Ffe, V1 K Final Inspection By A Date j 6 –Z-- ❑ SPECIAL PERMIT -Approved by Character of Soil to Depth of 3 Ft: Pit/ ump Soil Character: COMMENTS SPZ- %/er 1 nk cAn�JII/' P S PE Code SC INFO Received By Check#/ Cash Amount Remitted D to Permit/ Service Request # Invoice # Permit ID# 4ESLI 21 42-01 Cj� I3 (P `'e 34 --2Q1, ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18 T