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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT IP SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 NON-REFUNDABLE PERMIT CALL (209) 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS �� Cnr2>��/fOw /c��X __CITY/ZIP Et'4 CROSS STREET ;%�.y2 APN4 _�� -0' _7�./PARCEL2W1011,-_ac SIZE O -OWNER NAME (,/2CC� 2W101//T t'�J (' -4 q -c, _ 4 u'Iet- "PHONE OWNER ADDRESS 1 �O ^ 1/ ✓J CITY/STATE/ZIP ` CONTRACTOR l r ✓J{IJ L `lp/b — e�O%r� _ -_-_ . PHONE !' 5�z Z-7 CONTRACTOR ADDRESS 31 D/Saw h.� CITY/STATE/ZIP Z-cz- LICENSE ❑>C-42 n C-36 OTHER NUMBER ys l�y� EXPIRATION DATE CJ9,IZ 7 WATER TABLE DEPTH: 6d� —_I O C) ft GEOGRAPHICAL INFORMATION: Coordinates X Y 1.1 PERC TEST # BUILDING PERMIT # _ _ _ _ LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION REPAIR/ADUIIION ENGINEER DESIGNED /ALTERNATIVE REPLACEMENT /!"y!t OUT -OF -SERVICE SEPTIC SYSTEM x DESTRUCTION t�_69a4u_ INSTALLATION WILL SERVE: V RESIDENCE I I COMMERCIAL 11 OTHER NUMBER OF LIVING UNITS: �_ NUMBER OF BEDROOMS: 3 NUMBER OF EMPLOYEES: 2,I ';P�— SEPTIC TANK TYPE/MFG it L- _ CAPACITY A�160 gal # OF COMPARTMENTS .� ❑ GREASE TRAP TYPE/MFG CAPACITY _ gal # OF COMPARTMENTS DISTANCE TO NEARES R WELL _ /00 %-_ _ It FOUNDATION -30 , ft PROPERTY LINE SCS ft ❑ LIFT STATION SIZE TYPE OF PUMP--- _ ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) (� LEACH LINES D LEACHING CHAMBERS # OF LINES _ LENGTH OF LINES ft Permit/ Invoice # DISTANCE TO NEAREST WELL �CXJ + ft FOUNDATION �/O • ft PROPERTY LINE S� �' ft ❑ FILTER BED WIDTH _ --- ft LENGTH -_ ft DEPTH ft G� DISTANCE TO NEAREST WELL , _ __---- - — ft FOUNDATION -- - ft PROPERTYLINE ft ❑ MOUNDED WIDTH ft LENGTI I ft DEPTH DISTANCE TO NEAREST WELL _ ft FOUNDATION ft PROPERTY LINE DA ❑ SUMPS WIDTH ft LENGTH __ _ ft DEPTH n„_ DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE �Qy J ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH FN �AQlh., ftp, _ DISTANCE TO NEAREST WELL ft FOUNDATION _ ft PROPERTY LINE(I lfH"F 1' 46— SEEPAGE PITS NUMBER 3 WIDTH -31 ft DEPTH 41S �Td4 DISTANCE TO NEAREST WELL / •SD** y ft FOUNDATION OV ft PROPERTY LINE CDU 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. MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 SIGNED — _. _ _ TITLE_ G��/llt,/�+^= DATE 1—'14-//7 EPARTMENT SE ONLY Application Accepted By TA DateIF _ ' /[ _ Area _ Employee ID# Final Inspection By Date 17-11 ` ___i:,/( n SPECIAL PERMIT - Approved by Character of Soil to De of 3 Ft Pit/Sump Soil Character: COMMENTS�L LA _ • �� . ____ __ PE SC Received Check#/ Amount Date Permit/ Invoice # Permit ID# Code INFO B Cash_ Remitted Service Request # J �- G� 5910b7?qlo�7 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 5/5/17 T