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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 L;ALL ZUY 903-10Y/ FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUEI JOB ADDRESS /aL� _S y p F';•� C_ d..�/° 4 U CITY/ZIP CROSS STREET Dln!q[{-dn yeo APN PARCEL SIZE OWNER NAME/U%; G r� �- C� 'Q6 �9 9 PHONE OWNER ADDRESS CITY/STATE/ZIP CONTRACTOR (Mw I, Ae_"C 4 � c S�-�(• PHONE CONTRACTOR ADDRESS rj � nX (Q � � CITY/STATE/ZIP P- ►�//y ,F� CofJ� LICENSE ❑ C-42 ❑ C-36 OTHER NUMBER EXPIRATION DATE a WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT # 341 (, LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION I REPAIR/ADDITION ! ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM I DESTRUCTION INSTALLATION WILL SERVE: ESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: 1 NUMBER OF BEDROOMS: 41 NUMBER OF EMPLOYEES: 01 SEPTIC TANK ❑ GREASE TRAP ❑ LIFT STATION TYPE/MFG lAkL_ TYPE/MFG DISTANCE To NEAREST: WELL �(y SIZE TYPE OF PUMP ft CAPACITY !(jp a gal # OF COMPARTMENTS_ CAPACITY gal # OF COMPARTMENTS� FOUNDATION _a� , ft PROPERTY LINE ')J..j— ft ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) ❑ LEACH LINES LEACHING CHAMBERS Permit/ Service Request # Invoice # # OF LINES LENGTH OF LINES ft iqa I I DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft FILTER BED WIDTH to, ft LENGTH K S(I ft DEPTH �-xe6te_ ft DISTANCE TO NEAREST WELL i i j:6I ft FOUNDATION ��n t ft PROPERTY LINE % tr 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 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. 1V111V11V/V/V 4 17V 74L/VF1/VI,C 1vuIIl,C RC V1r[CIJ rur[ IIYJrCI,IIVIVJ - rLC/iJC {wHLL I LVJ Ja73-/OJ/ SIGNED TITLE mol tCec-4-4 T DATE S � � DEPARTMENII U E ONLY Application Accepted By �� l�L-- Date Area Employee ID#�� Final Inspection By Date S- Z! 2-7 ❑ SPECIAL PERMIT -Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: ,, ,w,// COMMENTS /llev�l S FrL - "j"y, l rpl fes, enGe. DaU a ep -0ter b6� PE Code SC INFO Received B Chec ash Amount Remitted Date Permit/ Service Request # Invoice # Permit ID# iqa I I 11 b vl� q 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18 T