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` ONSITE WASTEWATER TREATMENT SYSTEM PERMIT I/to z <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 <br />NON-REFUNDABLE PERMIT GALL ZO 953-7697 FOR INSPECTIONS LXPIRES 1 YEAR FROM UATE ISSUE[ <br />JOB ADDRESS CI CITY/ZIP Som <br />CROSS STREETyPr APN 03X • oo 99 PARCEL SIZE <br />OWNER NAME y PHOrn11DNE 1 T <br />OWNER ADDRESS ' _ _ CITY/STATE/ZIP�ij�o Ca <br />CONTRACTOR U&V( G -_ _ __ _ PHONE ComPn/' v&- / _ -5-0-�2 7 <br />CONTRACTOR ADDRESSW <br />CITY/STATE/ZIP il �/ <br />i <br />LICENSE El X-42 11 IC -36 OTHER NUMBER -V5 91,41-5 EXPIRATION DATE_ <br />WATER TABLE DEPTH: 40 ft GEOGRAPHICAL INFORMATION: <br />F77PERC TEST # BUILDING PERMIT # <br />TYPE OF WORK: ❑ NEW INSTALLATION X REPAIR/ADC <br />Coordinates X Y <br />LAND USE APPLICATION # <br />)N I I ENGINEER DESIGNED/ALTERNATIVE <br />❑ REPLACEMENT I OUT -OF -SERVICE SEPTIC SYSTEM I I DESTRUCTION <br />INSTALLATION WILL SERVE: RESIDENCE U COMMERCIAL 11 OTHER <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: 3 _ NUMBER OF EMPLOYEES: <br />❑ SEPTIC TANK TYPE/MFG <br />❑ GREASE TRAP TYPE/MFG <br />CAPACITY <br />CAPACITY <br />DISTANCE TO NEAREST: WELL ft FOUNDATION _ <br />❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT <br />gal # OF COMPARTMENTS <br />gal # OF COMPARTMENTS <br />ft PROPERTY LINE ft <br />❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />ElLEACH LINES X LEACHING CHAMBERS Q r # OF LINES LENGTH OF LINES440 <br />7Z� ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION 3a ft PROPERTY LINE <br />/00 ft <br />❑ FILTER BED WIDTH _ ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft <br />❑ SUMPS WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE To NEAREST WELL It FOUNDATION ft PROPERTY LINE ft <br />❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />, <br />SEEPAGE PITS NUMBER_ - WIDTH_- ft DEPTH ��' ft <br />DISTANCE TO NEAREST WELL aflO ft FOUNDATION 460 ft PROPERTY LINE /00 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 />24 <br />SIGNED <br />Application Accepted <br />Final Inspection ByG <br />Character of Soil to <br />COMMENTS _f!� <br />of 3 Ft: <br />cu run 11var-r-L. ) rvrvo - r-L.crroc L.r41-L- cva ago -i vii <br />TITLE DATE <br />TMENT SE ONLY <br />Date Area Employee ID#� <br />Date ❑ SPECIAL PERMIT - Approved by <br />____ P Sump Soll Character: <br />PE <br />SC <br />INFO <br />Received <br />B <br />Check#/ <br />Cash <br />Amount <br />Remitted <br />Date <br />Permit/Code <br />Service Request # <br />Invoice # <br />Permit ID# <br />�+ <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />5/5/17 <br />T <br />