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ONSITE WASTEWATEP TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 NON-REFUNDABLE PERMIT CALL 209 953-7697 FOAlNSP c l NS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESSL d p�_� �_ r, ITYRIP CROSS STREET ^GBL LL7(� APN O V U I ' PARCEL SIZE Mp(]� Men ti �� y Q�J -nwma c �% OWNER ADDRESS mLf 0� � 55:1/1_�``• _CITY/STATE/ZIP 77-tC4A CONTRACTOR 50.e n2 1 en SA. MaC. . PHONE CONTRACTOR ADDRESS 1950 _TA fA o _ C_ it CITY/STATE/ZIP-TrALrc l LICENSE 1-11 C-42 ❑ LJC-36 OTHER __ NUMBER Syy 4S 7 EXPIRATION DATE _ WATER TABLE DEPTH: Av , N ft J PERC TEST # BUILDING PERMIT # TYPE OF WORK: NEW INSTALLATION K R GEOGRAPHICAL INFORMATION: Coordinates X _ LAND USE APPLICATION # ENGINEER DI Y NED /ALTERNATIVE A REPLACEMENT OUT -OF -SERVICE SEPTIC, SYSTEM OV DESTRUCTION +*4444►� INSTALLATION WILL SERVE: RESIDENCE L COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: SEPTICTANK TYPE/MFG -�MQCAPACITY 12_5Li gal #OFCOMPARTMENTSL ❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS DISTANCE TO NEAREST: WELL _ ft FOUNDATION ID ft PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) ❑ LEACH LINES C LEACHING CHAMBERS # OF LINES LENGTH OF LINES ft DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE ft FILTER BED WIDTH .2o�_ _ ft LENGTH _ aS ft DEPTH ?, " ft DISTANCE TO NEAREST WELL - ft FOUNDATION jt/ i ft 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 NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft ❑ SEEPAGE PITS NUMBER WIDTH It DEPTH It DISTANCE TO NEAREST WELL ft FOUNDATION 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. MINIMUM 24-HOUfj ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 SIGNED l _ _ TITLE 40W1% e --r— DATE , 2 - 12 -/ 7 r 2017 DEPARTMENT USE ONLY o� �hrn�r!/ Application Accepted By Date la--/ a/�' Area Employee ID# Final Inspection By _ ____ Date �f Z 3 __ >(, SPECIAL PFRAAIT - Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: _. COMMENTS_ rrst.10I''MC le / /21)A SaJke -,1 L PE Code SC INFO Received By Check ash Amount Remitted Date Permit/ Service Request # Invoice # Permit ID# 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 5/5/17