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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT P✓ SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 NON-REFUNDABLE 7PERMIT CALL 209 953-7697 FOR INSPECTIONS ptXPIRES 1 YEAR FROM DATE ISSUEI JOB ADDRESS Z O2 71 lieyrLTES P,9 CITYRIP L'ODI_ (`J ZqZ CROSS STREET 061 A y� APN O 3 G 3 GG _ PARCEL SIZE OWNER NAME CJ?� A % yLG. l , n Ace- A R G aJ I Le PHONE OWNER ADDRESS P U h��) / --CITY/STATE/ZIP S� (A q9 2 L CONTRACTOR PHONE67mj�y-2 6774 6r/40(%E CA QS-7 S�CONTRACTORADDDRESS Phi 6cy `(,!I .O-= CITY/STATE/ZIP _ � � � � LICENSE ❑t'!C-42 ❑❑C-36 OTHER NUMBERS 3 Le EXPIRATION DATE WATER TABLE DEPTH: V n �1°�U �+tl ^ ft GEOGRAPHICAL INFORMATION: Cl PERC TEST # BUILDING PERMIT #� TYPE OF WORK: 11NEW INSTALLATION REPAIR/ADE Coordinates X Y_ LAND USE APPLICATION # )N I I ENGINEER DESIGNED 'I1 HEPLACEMENT m INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ^n ❑ OTHER NUMBER OF LIVING UNITS: ' NUMBER OF BEDROOMS: oL NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPE/MFG ❑ GREASE TRAP TYPE/MFG DISTANCE TO NEAREST: WELL ❑ LIFT STATION SIZE TYPE OF PUMP TERNATIVE CAPACITY gal # OF COMPARTMENTS CAPACITY gal # OF COMPARTMENTS ft FOUNDATION _ ft PROPERTY LINE ft ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) ❑ LEACH LINES ❑ LEACHING CHAMBERS Check#/ Cash Amount Remitted # OF LINES Permit/ Service Request # LENGTH OF LINES It y 1 I u 115 DISTANCE TO NEAREST WELL SC. If FOUNDATION P_ V67F ft PROPERTY LINE ft ❑ FILTER BED WIDTH _. ft LENGTH _ ft DEPTH It DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ MOUNDED WIDTH tt ft LENGTH ti ft DEPTH It ft DISTANCE To NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft SUMPS WIDTH - ft LENGTH 12- ft DEPTH I It DISTANCE TO NEAREST WELL � V ft FOUNDATION 60 ft PROPERTY LINE `S U ft ❑ DISPOSAL PONDS WIDTH It LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH It DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE 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 B Final Inspection By Character of Soil to D4 COMMENTS T 7 ro ANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL TITLEQLA)tO� DATE J 1 A-114 A"' DEPARTMENT USE ONLYyDate U' '� Area f- "r Employee ID# Date 1 1 q 11} L1 SPECIAL PERMIT -Approved by th of 3 Ft: `• -A,^&4 Pit/Sum So}'I Character: 'a. &q cAay er �_ LG+t% I r1 i I!4rA4id ��/'� Icy SN►YIYaS 4-1 nh S (. fu b rPAu �edl '� -� 1 tach V%V*6 wece. PE Code SC INFO Received B Check#/ Cash Amount Remitted D to Permit/ Service Request # Invoice # Permit ID# y 1 I u 115 SC. 1 P_ V67F 42-01 �) /CJ``� / ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 5/5/17 v;