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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT pv/--- SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT # OF LINES LENGTH OF LINES ft 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 NON-REFUNDABLE PERMIT CALL (209) 9953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED , s JOB ADDRESS J �j S I-, w e-�� 9r AA /�� CITYRIP 7A j.tL. It DEPTH ft DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft 3O / ' CROSS STREET nIT>ex FOUNDATION ft PROPERTY LIR It APN PARCEL SIZE I' OWNER NAME "A f ��,l�61-b -//' �A -rICj- PHONE TU 1771")o {] ( OWNER ADDRESS b7"�6 G ,, VV u�-r FtP%. / v --CITY/STATE/ZIP me'--�`: 0 CONTRACTOR �' 7 1 i1��/3� I_�} �'1'K- 1 ' S, PHONE �i r`nnrrDArrnD AnnDGQC !� � F '� l`�f" //7 l,� ,�/►� CITY/STATF/71P /� L.S-, /yam ( } A l �i t l -f-.e0 � Cif • J J Jt. LICENSE ❑ i C-42 [1i C-36 OTHER NUMBER (p6t5S.4 -EXPIRATION DATE WATER TABLE DEPTH:%A/t`/1�i/IA��_ It GEOGRAPHICAL INFORMATION: Coordinates X Y 7PERC TEST # BUILDING PERMIT # LAND USE APPLICATION #_ TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESA REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION _ D/ALTERNATIVE INSTALLATION WILL SERVE: 'RESIDENCE ❑ COMMERCIAL I OTHER NUMBER OF LIVING UNITS: ' NUMBER OF BEDROOMS:— J NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPE/MFG ❑ GREASE TRAP TYPE/MFG CAPACITY CAPACITY DISTANCE To NEAREST: WELL _ It FOUNDATION ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT gal # OF COMPARTMENTS gal # OF COMPARTMENTS It PROPERTY LINE ft ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) ❑ LEACH LINES CI LEACHING CHAMBERS # OF LINES LENGTH OF LINES ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft FILTER BED WIDTH ft LENGTH .Z 1 ft DEPTH I, ft DISTANCE TO NEAREST WELL ft p X3 FOUNDATION �i'ft PROPERTY LINE 0 It ❑ MOUNDED WIDTH ft LENGTH It DEPTH ft DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft ❑ SUMPS WIDTH _ It LENGTH ft DEPTH PAYMEN\ T It DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LIR It El DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH It DISTANCE TO NEAREST WELL _ It FOUNDATION ft PROPERTY L �2nn— It ❑ SEEPAGE PITS NUMBER WIDTH _ ft DEPTH It DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY �fP AQUIN COUNTY ft I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDAF]CE'FM�AN 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. SIGNED Application Accepted R1, Final Inspection By Character of Soil to Depth of 3 Ft: COMMENTS --ri SIL IT, ONCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 ■F—� _ TITLE. C >/N tt' c— DATE I J-) E P A R T M E N T JJ S E ONLY 6) q Date Area - ` Employee ID# Date L L ❑ SPECIAL PERMIT - Approved by 4 •r• Pit/Su p Soil Character:._ PE Code SC INFO Received By- ash Amount Remitted Date Permit/ Service Request # Invoice # Permit ID# 2(0 7 a 5 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 5/5/17 T