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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT F/ SAN JOAOUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 NON-REFUNDABLE PERMIT CALL (209) 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS / 412 W V eOQCITY/ZIP ID I P_ :rf P H 7l CROSS STREET Ai / APN /J 1 % U 3 PARCEL SIZE ' OWNER NAME -S ey e- _JPARCEL,2 ^g'l /�/esm C r PHONE—,? /& QAJ r �j0 SoD OWNER ADDRESS J CITY/STATE/ZIP yestJCea ei &AAc, CONTRACTOR ❑ MOUNDED - PHONE �I'/-b �CA 47 9�CONTRACTOR ADDRESS / CITY/STATE/ZIP IJ -O J/A4O LICENSE gADG-42 1 C-36 OTHER NUMBER �7��d EXPIRATION DATE FOUNDATION WATER TABLE DEPTH: 1/ 110 ft GEOGRAPHICAL INFORMATION: Coordinates X Y PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION I REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE x REPLACEMENT i q n / S Irl OUT -OF -SERVICE SEPTIC SYSTEM ,+ DESTRUCTION 4 G n K INSTALLATION WILL SERVE: LY RESIDENCE L COMMERCIAL L OTHER NUMBER OF LIVING UNITS: / NUMBER OF BEDROOMS: Z NUMBER OF EMPLOYEES: SEPTIC TANK TYPE/MFG /" J� L- ❑ GREASE TRAP TYPE/MFG DISTANCE TO NEAREST: WELL CAPACITY IU OO gal # OF COMPARTMENTS aL CAPACITY gal # OF COMPARTMENTS ft FOUNDATION ft PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT Ir LEACH LINES LEACHING CHAMBERS DISTANCE TO NEAREST WELL It ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) # OF LINES FOUNDATION D ft LENGTH OF LINES J J ft o � PROPERTY LINE In ❑ FILTER BED WIDTH ft LENGTH Chec ash ft DEPTH ft Permit/ Service Request # DISTANCE TO NEAREST WELL ft FOUNDATION 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 ft FOUNDATION ft PROPERTY LINE ft / U" SEEPAGE PITS NUMBER WIDTH w /I ft DEPTH /2S / ft DISTANCE TO NEAREST WELL ft FOUNDATION ! / ft PROPERTY LINE J / 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 AKO THAT I AM IN COMPLIANCE WITH ALL WORKERS COMPENSATION LAWS. MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - SIGNED Application Accepted By Final Inspection By� Character of Soil to D tl COMMENTS A e- - L.. DATE —7"l4 '—Ir I IVIG IV I UJC V IV L I Date I L ' (Y Area Employee ID#� Date D ❑ SPECIAL PERMIT - Approved by J Pit/Sump Soil Character: ,..g Ion PE Code SC INFO Received B Chec ash Amount Remitted Date Permit/ Service Request # Invoice # Permit ID# 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 5/5/17 71 y 0