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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN CO3NTY ENVIRONMENTAL HE LTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 NON-REFUNDABLE PERMIT/ 7, J• CALL (209) 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS . .�A�� AWALZ;My /gt/�_ _ _ - CJITY/ZIP Z /" WRar YS -33.0 CROSS STREET A607-A4AP, _ APN � _¢�3a- D� PARCELSIZE OWNERNAME /1D? V -I_ PHONE 411- 1dg-3a3/ OWNER ADDRESS ��33 11AA/TNE�/ "rD _ CITY/STATE2IP iLATN_2aP G'�4^95330 6 CONTRACTOR NF 60 Alf It L� _ PHONE la � �DZ -I6 saA'44- �fS� c CONTRACTOR ADDRESS[?. ` ff O X 3-_71_4_ CITY/STATE/ZIP _77 -VR L -04K e/A ?g LICENSE ❑' .C-42 ❑ JC -36 OTHER -fz _e_L NUMBER 77 4 EXPIRATION DATE_ "o� ha WA R TABLE DEPTH: A"//- it GEOGRAPHICAL INFORMATION: PERC TEST #.1 BUILDING PERMIT # TYPE OF WORK: NEW INSTALLATION REPAIR/ADC REPLACEMENT I J OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION _ Coordinates X Y LAND USE APPLICATION # )N ENGINEER DE II INSTALLATION WILL SERVE: I 1 RESIDENCE ❑ COMMERCIAL I I OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPE/MFG ❑ GREASE TRAP TYPE/MFG DISTANCE TO NEAREST: WELL ❑ LIFT STATION SIZE TYPE OF PUMP CAPACITY CAPACITY ft FOUNDATION _ ❑ PKG TX PLANT /ALTERNATIV gal # OF COMPARTMENTS gal # OF COMPARTMENTS it PROPERTY LINE it ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) ❑ LEACH LINES - LEACHING CHAMBERS # OF LINES LENGTH OF LINES DISTANCE TO NEAREST WELL it FOUNDATION _ it PROPERTY LINE ❑ FILTER BED WIDTH it LENGTH _ it DEPTH DISTANCE TO NEAREST WELL it FOUNDATION ----it PROPERTY LINE ❑ MOUNDED WIDTH it LENGTH _ it DEPTH DISTANCE TO NEAREST WELL it FOUNDATION it PROPERTY LINE ❑ SUMPS WIDTH __ ____ it LENGTH _ it DEPTH DISTANCE TO NEAREST WELL it FOUNDATION it PROPERTY LINE ❑ DISPOSAL PONDS WIDTH it LENGTH it DEPTH DISTANCE TO NEAREST WELL it FOUNDATION _ it PROPERTY LINE ❑ SEEPAGE PITS NUMBER WIDTH it DEPTH DISTANCE TO NEAREST WELL it FOUNDA"1 ION ft PROPERTY LINE 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 COINWENSATION LAWS. 24 HOCAAADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL Application Accepted I Final Inspection By Character of Soil to De COMMENTS it it it it it it it it it it it it 1-1 r' EPARTMEN USE ONLY .►��j � f� Date Area 1 — Employee ID# A t�%) Date 1��3p�� ❑ SPECIAL PERMIT - Approved by of 3 t. _ Pit/Sump Soil Character: _ PE Code SC INFO Received B ash Amount Remitted Date Permit/ Service Request # Invoice # Permit ID# 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 5/5/17