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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 (:ALL LUy Y0.5 -/by/ FOR INSPECTIONS tXPIRES l YEAR FROM UATE ISSUE JOB ADDRESS 7 �' �eS' CITY/ZIP to G CROSS STREET /\ J �-))4 -e �� APN O � d Q ©I UQ 1 PARCEL SIZE 3 � I q OWNER NAME �(A L eq ❑ LIFT STATION PHONE PKG TX PLANT SCi WELL ft FOUNDATION ft PROPERTY LINE ft OWNER ADDRESS h17 f— WIDTH CITY/STATE/ZIP ft DEPTH ft ` / & �� �G 61 2 / �J 3 C��~��O�/,/q/ CONTRACTOR ft V G PHONE WIDTH ft LENGTH ft DEPTH ft ��E�TGI�/. /5,�� CONTRACTOR DISTANCE TO NEAREST WELL Pec CITY/STATE/ZIP ( f ``AA�DDRESS LICENSE 11,q 642 ❑'_ C-36 OTHER NUMBER —EXPIRATION DATE ft DEPTH ft WATER TABLE DEPTH: r+ ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # TYPE OF WORK: I NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED /ALTERNATIVE REPLACEMENT OUT -0F -SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: ' NUMBER OF BEDROOMS: 3 NUMBER OF EMPLOYEES: 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. Final Inspection Byl Date Z,. ��,`-� J C)ZM SPECIAL PERMIT -Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS i yy� -% "er"Ln' PE SC Received ec Code INFO B ash LEACH LINES LEACHING CHAMBERS # OF LINES I LENGTH OF LINES 55" ❑ SEPTIC TANK TYPE/MFG Sf'7 C CAPACITY gal # OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS FILTER BED DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) 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. Final Inspection Byl Date Z,. ��,`-� J C)ZM SPECIAL PERMIT -Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS i yy� -% "er"Ln' PE SC Received ec Code INFO B ash LEACH LINES LEACHING CHAMBERS # OF LINES I LENGTH OF LINES 55" ft DISTANCE TO NEAREST o WELL Z / i ft FOUNDATION ZOO ft PROPERTY LINE CJ 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 ft DEPTH �sJ ft DISTANCE TO NEAREST WELL O ft FOUNDATION /lU O ft PROPERTY LINE C ft 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. Final Inspection Byl Date Z,. ��,`-� J C)ZM SPECIAL PERMIT -Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS i yy� -% "er"Ln' PE SC Received ec Code INFO B ash Amount Remitted ate Permit/ Invoice # Permit ID# Service Request # S�C.n 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18