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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 HERMIT CALL (ZUY) Y53-lbbll FOR INSPECTIONS LXPIRES 1 YEAR FROM DATE ISSUEI JOB ADDRESS 53 -l-lt s �� CITY/ZIP M Cytd.z:-a/q CROSS STREET Q I'L-A de- APIN a 0 0.5 03 PARCEL SIZE 7o - I OWNER NAME M454&rs6d V)er«i (/ ,ts(n Ann PHONE OWNER ADDRESS �J • N ox y a� y/'l CITY/STATE/ZIP/- /� 4 N / ece 9$- D-7 CONTRACTOR , r �� I�� L/R �`a C }C %' PHONE ,�/��a-p(!� CONTRACTOR ADDRESS I-1.� %��/ O.J O CITY/STATE/ZIP VV 1sAf-4e 4-r(f^ LICENSE ❑l C-42 ❑I IC -36 OTHER NUMBER D EXPIRATION DATE Q jaa WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT # dOO T93 LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION C REPAIR/ADDITION L ENGINEER DESIGNED /ALTERNATIVE I I REPLACEMENT l OUT -OF -SERVICE SEPTIC SYSTEM I DESTRUCTION INSTALLATION WILL SERVE: ESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: —31 NUMBER OF EMPLOYEES: Application Accepted B Final Inspection By Character of Soil to Depth of COMMENTS hJp j SF ,MCI gjcUY►dWA 1'er DEPARTMENTUS E ONLY J L Date _71&61.7a Area 3Lq Employee ID# '1 Date T/Z ❑ SPECIAL PERMIT -Approved by Pit/Sump Soil Character: 444rd 'plc/ J rt Cr 4 • EW2r hec 'tJ he nr [ r. g God 6 F ; I s era�lo Pva1 House C/—Dy—p c6d ip c ba >I fGi PE Code SC INFO Received By, P"I'S EPTIC TANK TYPE/MFG ! T CAPACITY gal # OF COMPARTMENTS Invoice # ❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS DISTANCE TO NEAREST: WELL o6 I ft FOUNDATION knt ft PROPERTY LINE 7O 9` ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) ❑ LEACH LINES LI LEACHING CHAMBERS # OF LINES LENGTH OF LINES ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft FILTER BED WIDTH 'i01 ft LENGTH l -{0I ft DEPTH (CII ft DISTANCE TO NEAREST WELL /,A,-, ft FOUNDATION �1 ft PROPERTY LINE (bi 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. MINIMUM 08 HO ADVANCE NOTICE REQUIRED FOR INSPECTIONS -PLEASE CALL 209)953-7697 SIGNED TITLEDATE / Application Accepted B Final Inspection By Character of Soil to Depth of COMMENTS hJp j SF ,MCI gjcUY►dWA 1'er DEPARTMENTUS E ONLY J L Date _71&61.7a Area 3Lq Employee ID# '1 Date T/Z ❑ SPECIAL PERMIT -Approved by Pit/Sump Soil Character: 444rd 'plc/ J rt Cr 4 • EW2r hec 'tJ he nr [ r. g God 6 F ; I s era�lo Pva1 House C/—Dy—p c6d ip c ba >I fGi PE Code SC INFO Received By, Check# AmountPermit/ Remitted Date Service Request # Invoice # Permit ID# ail )i� Z , zL 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18