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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAOUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 <br />NON-REFUNDABLE PERMIT) GA 2c09 953-7597 FOR INSPECTIONS EXPIRES 1 YEAR FROM UATE ISSUEI <br />JOB ADDRESS ` A O ✓Qi Qc///i CITY/ZIP j%r�C <br />CROSS STREET 1 t r �(% I APN V V 10101 u PARCEL SIZE I -A -T -T- <br />OWNER NAME � e-56, co, -Cr { n IL( ei72-ac <br />PHONE <br />OWNERADDRESS o2lLlw anison 9A -_ CITY/STATE/ZIP 2-acI/ CA 15-30 <br />GINTRACTORCir��1ci�T PHONE .D 9•--�_%�� <br />CONTRACTOR ADDRESS 1�::19N`� C- Gr u_ CITY/STATE/ZIP _ !�G�NQ� 2j-1 LP <br />LICENSE LL C-42 ❑_ C-36 OTHER NUMBER T�[p��J /_ - EXPIRATION DATE_�/ a <br />WATER TABLE DEPTH: It GEOGRAPHICAL INFORMATION: Coordinates X Y <br />Ll PERC TEST # BUILDING PERMIT # _LAND USE APPLICATION # <br />TYPE OF WORK: NEW INSTALLATION, REPAIR/ADDITION ENGINEER DESIGNED /ALTERNATIVE <br />•1 <br />REPLACEMENT + 1 OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION <br />INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL L I OTHER_ <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: I NUMBER OF EMPLOYEES: <br />SEPTIC TANK TYPE/MFG Ql+ _ _ 60✓11.r'2l}- CAPACITY %WU gal # OF COMPARTMENTS <br />LIGREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS <br />DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br />❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT O SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />l <br />LEACH LINES <br />LEACHING CHAMBERS F/J 3(0 K:rnL (:Zvt _ # OF LINES <br />Z <br />LENGTH OF LINES <br />3y ft <br />Area <br />Employee ID# <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />2S <br />ft PROPERTY LINE <br />S ft <br />❑ <br />FILTER BED <br />WIDTH __ <br />ft LENGTH <br />P lute <br />ft <br />DEPTH <br />It <br />a S -I" JAVA -- <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />_ ft PROPERTY LINE <br />It <br />❑ <br />MOUNDED <br />WIDTH <br />ft LENGTH <br />ft <br />DEPTH <br />ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />It PROPERTY LINE <br />It <br />❑ <br />SUMPS <br />WIDTH <br />ft LENGTH <br />ft <br />DEPTH <br />It <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE <br />It <br />❑ <br />DISPOSAL PONDS WIDTH <br />It LENGTH <br />ft <br />DEPTH <br />ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE <br />ft <br />❑ <br />SEEPAGE PITS <br />NUMBER <br />WIDTH <br />It DEPTH <br />ft <br />DISTANCE To NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE <br />ft <br />I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN <br />JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br />CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br />WORKERS COMPENSATION LAWS. <br />SIGNED <br />ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL <br />C. TITLE fir' DATE d-13-17 <br />PE <br />Code <br />- REPARTMENT USE ONLY <br />S <br />/ <br />Application Accepted y <br />Date <br />Area <br />Employee ID# <br />Final Inspection By q� <br />/' <br />Date �1YA <br />�( SPECIAL PERMIT - Approved by <br />Character of Soil to Depth of 3 Ft:1--j <br />Pit/Sump Soil <br />Character: <br />COMMENTS iter 1• <br />1-Uw "A1 l iru4:on. ?An �- <br />Gu✓e <br />P lute <br />�-G . 1L I i n C C <br />0 r.✓' f o n P r m -V— <br />4 Q <br />a S -I" JAVA -- <br />PE <br />Code <br />Sc <br />INFO <br />Received <br />B <br />Check#/ <br />Amount <br />Remitted <br />Date <br />Permit/ <br />Service Re uest # <br />Invoice # <br />Permit ID# <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />5/5/17 <br />T <br />