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ONSITE WASTEWATER TRE -ATM ENT SYSTEM PERMIT ffl SAN JOAOUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 PION -REFUNDABLE PERMIT CALL 20/9) 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED � JOB ADDRESS , t Z N AoGr ` J^ `J CITY/ZIP L qz:.' I- C-1' CROSS STREET ,� I �J R� / /� APN PARCEL SIZE �. 6 7 OWNER NAME i1�1 �I� aJ h L / �/ wL 1 1 I / `� PHONE 471 `W OWNER ADDRESS �I�(�E {1i �-`6�!/l // fG / AM� CITY/STATE/ZIP 19 L CONTRACTOR YV ES -T ��+.��%) PHONE =J .-7 3 9 CONTRACTOR ADDRESS J� M/�� L- 1 ` CJ 1 CITY/STATE/ZIP �nJ LICENSE 1] I C-42 1-1f�si C-36 OTHER A NUMBER `� s-7 EXPIRATION DATE WATER TABLE DEPTH: 6U — n V ft GEOGRAPHICAL INFORMATION: ITPERC TEST # —71 BUILDING PERMIT # 'TYPE OF WORK: NEW INSTALLATION I I R PAIR/ADE X Y LAND USE APPLICATION # ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM I . DESTRUCTION INSTALLATION WILL SERVE: RESIDENCE 11 COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: IL_ NUMBER OF EMPLOYEES: SEPTIC TANK TYPE/MFGI'— ❑ GREASE TRAP TYPE/MFG CAPACITY 1 Z�J gal # OF COMPARTMENTS 17— CAPACITY gal # OF COMPARTMENTS 1 DISTANCE TO NEAREST: WELL I (10 f ft FOUNDATION `7 'f ft PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP____ _ _ ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) LEACH LINES LEACHING CHAMBERS N�� # OF LINES LENGTH OF LINES 64D ft 1 DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft L] FILTER BED WIDTH It LENGTH ft DEPTH It DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE------- It C] 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 LINF ft X SEEPAGE PITS NUMBER Z WIDTH ` _ft DEPTHvs ft DISTANCE TO NEAREST WELL S -� ft FOUNDATION J , ft PROPERTY LINE Lil ft I HFREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN „JAQUIN 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 COMPENS_4TjpN LAWS. 1I111/y1MU1V11%Lnuy1Y f4uyfi1VL r: ►vullur_ rlcwUlricu run livor-E:U '►v1va - tcu SIGNED _ TITLE__. _ II Lb 0 C N'J DATE Application Accepted Final Inspection By_ Character of Soil to D COMMENTS AMM103 Area Employee I D# Dat Dat PE Code Sc INFO Received B Check#/ Amount Cash Remitt d Date Permit/ Service Request # Invoice # Permit ID# Z>t3 171.5 y 42-01 5/5/17 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT