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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT P ✓ SAN JOAQUIN 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 ISSUE[ JOB ADDRESS I -4OGL% MW V 120 CITY/ZIP 53bf, n ZHS `^ CROSS STREET-M�rd.a Ra.A _ _ APN _ 060 - PARCEL SIZE _ - OWNER NAME yc W� �Gro"D N I Isom &*k-- PHONE �11 �j OWNER ADDRESS now HWM 1-w �►y am 90 CITY/STATE/ZIPUp1 g536b CONTRACTOR C.11[[/��• 8r'ViOA + Se -As PHONE (��" Via-�3a�, CONTRACTOR ADDRESS VB� O -t clAjm Mt • -CITY/STATE/ZIP 65MI - CA g537, LICENSE ❑ C-42 111C-36 OTHER A. NUMBER S*1Sz EXPIRATION DATE__ IZI3III� WATER I ABLE DEPTH: - Il UtULIKAYIIIGAL INrUHMAIIUN: L.UUIu1110LUa n PERC TEST # BUILDING PERMIT # LAND USE APPLICATION #_ TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DE l REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION IGNED /ALTERNATIVE INSTALLATION WILL SERVE: ❑ RESIDENCE COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: 30 ( SEPTIC TANK TYPE/MFG Cww,,,+L L ("%CH 'L CAPACITY (Z) ❑ GREASE TRAP TYPE/MFG CAPACITY DISTANCE TO NEAREST: WELL _ It FOUNDATION ❑ LIFT STATION SIZE TYPE OF PUMP___ __ ._. ❑ PKG TX PLANT SCO gal # OF COMPARTMENTS L gal # OF COMPARTMENTS ft PROPERTY LINE ft ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) LEACH LINES ❑ LEACHING CHAMBERS # OF LINES �L LENGTH OF LINES ft 7\ 150 f /� f'�`Z'- U i I Vy ft DISTANCE TO NEAREST WELL ft FOUNDATION 1✓ It PROPERTY LINE ❑ FILTER BED WIDTH _ It LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft ❑ MOUNDED WIDTH _ ft LENGTH ft DEPTH _ ft DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft ❑ SUMPS WIDTH _ It LENGTH ft DEPTH It DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE It 1 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 COMPENSATION LAWS. MINIMUM 24 HOUR A VANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 SIGNED PE _ _ TITLE Ir-1XI FAAa^nu / DATE I- 25 -11 V ' DEPARTMENT USE ONLY / Applicatlon Accepted Dy _ _ Data U- - Area � Employee ID# A h rn ey Final Inspection By Date 11 SPECIAL PERMIT -Approved by Character of Soil to Depth of 3 Ft:--- Pit/Sump Soil Character: COMMENTS Nov U,/QJ bq (' u At d—Adx. _ J CSM" I!'_ --nd�ec�iow UK 3421)/ f/• -- ' eyc/ fih.r % iht,.cc /S 1,. .- it/d / }%rrS PE Code SC INFO Received B Check#/ Cash Amount Remitted Permit/ Date Service Request # Invoice # Permit ID# 4XI C 15 U (0 10 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 5/5/17