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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT � ' 36 ?Of- f14 SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT \-A"A/- 1868 E. HAZE LTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 OWNER NAME OWNER ADDRESS P15 ��,��j�/� �✓J_✓ b,�1J CONTRACTOR CONTRACTOR ADDRESS LICENSE ❑ C-42 ❑ C-36 OTHER PARCELSIZE PHONEPy CITY/STATE/ZIP RIC M 1'(7 0 CA Ot PHONE ___ -CITY/STATE/ZIP NUMBER EXPIRATION DATE I �I "�^� t WATER TABLE DEPTH: t O l ! -0 ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT # Q __ LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM I 1 DESTRUCTION INSTALLATION WILL SERVE: 'RESIDENCE [I COMMERCIAL n D OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: - _ y NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPE/MFG KI Alt, CAPACITY gal # OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS ❑ LEACHING DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP _ _.- ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL WORKERS COMPENSATION LAWS. SIGNED Application Accepted 8y ALAI Final Inspection By� Character of Soil to Depth of 3 Ft: COMMENTS -0( 'CE NOTICE REQUIRED_ FOR INSPECTIONS - PLEASE CALL 209 953-7697 --- TITLE f�, _ DATE (f:) L -t- �ii d V? 0 ■■■■- I■■■ ■■PEAME ■ ■ ■■■�i�f1�r■■■�■■�nr■�S ■■■■■■■■IIINEENNE U . DEPARTMENTU EONLY >_ Date_ _ _ Area "1 %� q_ Employee ID#�Y� Date 1` - l� ❑ SPEC)AL PER IT - Approved by Pit/Sump Soil Character: _- -- _"7- 4�; a . PE Code SC INFO CHAMBERS _... ... ....... # LINES �_ LENGTH OF LINES �/ ft Permit/ Service Re st._ LEACH LINES ❑ LEACHING PAO OF t DISTANCE TO NEAREST WELL --- ft FOUNDATION It PROPERTY LINE C1 It ❑ FILTER BED WIDTH ft LENGTH _ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION It 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 NEARE=ST WELL It FOUNDATION ft PROPERTY LINE ft ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NE ST WELL ft FOUNDATION ft PROPERTY LINE ft SEEPAGE PITS NUMBERy WIDT�H�_� ft DEPTH �i� � � ft J ` DISTANCE TO NEAREST ' WELL 170 V- ft FOUNDATION / ft PROPERTY LINE _ b ft I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL WORKERS COMPENSATION LAWS. SIGNED Application Accepted 8y ALAI Final Inspection By� Character of Soil to Depth of 3 Ft: COMMENTS -0( 'CE NOTICE REQUIRED_ FOR INSPECTIONS - PLEASE CALL 209 953-7697 --- TITLE f�, _ DATE (f:) L -t- �ii d V? 0 ■■■■- I■■■ ■■PEAME ■ ■ ■■■�i�f1�r■■■�■■�nr■�S ■■■■■■■■IIINEENNE U . DEPARTMENTU EONLY >_ Date_ _ _ Area "1 %� q_ Employee ID#�Y� Date 1` - l� ❑ SPEC)AL PER IT - Approved by Pit/Sump Soil Character: _- -- _"7- 4�; a . PE Code SC INFO Received By Check#/ Cash Amount Remitted ate Permit/ Service Re st._ Invoice # Permit ID# PAO 15 42-01 ONSI FE WASTEWATER TRTMNT SYSTEM PERMIT 5/5/17