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ONSITE WASTEWATIER 'f NT SYSTEM PERMIT SAN JOAOUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 'NON-REFUNDABLE PERMIT CALF (2019 053-7697FOR INSPECTIONS EXPIRES 1 DEAR FROM DATE ISSUED JOB ADDRESS f�/ / J E sC. C// 1-1 C/' �{ CITY/ZIP -I C G CJ CROSS STREET 1 ^I'_Ci�GI i APN O G S 3 g o Ll y (I PARCELSIZE Ci OWNER NAME 'Irr OWNER ADDRESS CONTRACTOR Y CONTRACTOR ADDRESS LICENSE i-1' C-42 ❑ I C-36 OTHER '/ PHONE C -CITY/STATE/ZIP V Ci4 PHONE- W7 g� 3 �9 _ --CITY/STATE/ZIP NUMBER EXPIRATION DATE___ WATER TABLE DEPTH: 0 ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT # P5-j9&36j3 LAND USE APPLICATION # TYPE OF WORK: X NEW INSTALLATION I REPAIR/ADDITION i ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM I I DESTRUCTION INSTALLATION WILL SERVE: X_RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: I NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: SEPTIC TANK ❑ GREASE TRAP ❑ LIFT STATION TYPE/MFG f 04C re fP TYPE/MFG DISTANCE TO NEAREST: WELL SIZE TYPE OF PUMP CAPACITY lz a o gal # OF COMPARTMENTS CAPACITY (gal # OF COMPARTMENTS 1t FOUNDATION 10 __. ft PROPERTY LINE ), L ft __ ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) C Y _ LEACH LINES LEACHING CHAMBERS WELL # OF LINES 2 LENGTH OF LINES 9- SS it ft PROPERTY LINE ft DISTANCE TO NEAREST WELL Ofl It FOUNDATION 3U ft PROPERTY LINE I U It ❑ FILTER BED WIDTH ft LENGTH /00 ft DEPTH 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. ,, Application Accepted By Final Inspection By Character of Soil to D t COMMENTS PLEASE CALL (209) 953-7697 0 f DATE DEPARTMENT U�QNL Date�.�Area �j� Employee ID# Ldk, Date A ❑ SPECIAL PERMIT - Approved by Pit/Sump Soil Character: PE Code DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ MOUNDED WIDTH ft LENGTH p ?- ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It ❑ SUMPS WIDTH It LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL _ ft FOU14DATION ft PROPERTY LINE_ ft ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL it FOUNDATION ft PROPERTY LINE ft i SEEPAGE PITS NUMBER ,- WIDTH ft DEPTH �� ft DISTANCE TO NEAREST �+5-,Fri' WELL 150 i ft FOUNDATION V)U -Y ft 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. ,, Application Accepted By Final Inspection By Character of Soil to D t COMMENTS PLEASE CALL (209) 953-7697 0 f DATE DEPARTMENT U�QNL Date�.�Area �j� Employee ID# Ldk, Date A ❑ SPECIAL PERMIT - Approved by Pit/Sump Soil Character: PE Code SC INFO Received B Check#/ Cash Amount Remitted Permit/ Date Service Request # Invoice # Permit ID# q;, I I p ?- z 72&4-00'7 85ta 42-01 ONSITE WASTEWATER TRTMNI SYSTEM PERMIT 5/5/17