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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 NON-REFUNDABLE PERMIT// LEACH LINES CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUEI JOB ADDRESS 0 £ �lN `fes (�(fc`I� CCIITYIZIP O C CROSS STREET �0 w 1 e j ft FOUNDATION So ZArezollo APN nn li %VITD J PARCEL SIZE g OWNER NAME Sg S C 420 V40 PHONE OWNER ADDRESS DEPTH ft ( _-CITY/STATE/ZIP �1w CONTRACTOR I f / �7!! � , gh,�`T�q PHONE �a C/ / �/�01P / CONTRACTOR ADDRESS �J 0 ,jc /,`�'C`/_' �S O -1 !�/✓• CITY/STATE/ZIP ` 96 I " LICENSE I 142 1 1 C-36 OTHER NUMBER �/r=T� EXPIRATION DATE DISTANCE TO NEAREST -f ..,) ft FOUNDATION ft PROPERTY LI I..Aj ft APR WATER TABLE DEPTH: V k __ N.;� V ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION R PAIR/ADDITION ENGINEER DESIGNED /ALTERNATIVE REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: RESIDENCE Li COMMERCIAL 1� OTHER NUMBER OF LIVING UNITS: //' . �i NUMBER OF BEDROOMS: � NUMBER OF EMPLOYEES: SEPTIC TANK TYPE/MFG Lo �K/r 'e0 L CAPACITY /..-�LD O gal # OF COMPARTMENTS C;1 ❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE / ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) 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 COMPENSATION LAWS. MINIMUM 24 HOUR ADVANCE NOTI E REQUIRED FOR INSPECTIONS -jPLEASE CALL (209) 953-769�/7 /�j SIGNED ' G TITLE J1✓>�i17`r»- DATE � lG !(O Application Accepted X Final Inspection ByQ�G Character of Soil to Depth of 3 COMMENTS INI S TMENT S LY Date / Area Employee ID#� Date SPE IAL ERMIT - Approved by Pit/Sump Soil Character: PE Code LEACH LINES LEACHING CHAMBERS # OF LINES 1 -3 LENGTH OF LINES ft Date Permit/ Service Request # DISTANCE TO NEAREST WELL ft FOUNDATION So ft PROPERTY LINE ft ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LI ft ❑ MOUNDED WIDTH ft LENGTH ft DEPTHCEIV-_�___ ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LI I..Aj ft APR ❑ SUMPS WIDTH ft LENGTH ft DEPTH 18 a-- ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPER )�n--- ft ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH E RnAll COuN ft SEEPAGE PITS DISTANCE TO NEAREST NUMBER WELL WIDTH '! ft FOUNDATION„ -776 It �lv IAL ft PROPERTY L E" OEPgt?r ft DEPTH p7S ft DISTANCE TO NEAREST r� WELL / / O ' ft FOUNDATION 740 ' ft PROPERTY LINE �Q� ✓ 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 AND THAT I AM IN COMPLIANCE WITH ALL WORKERS COMPENSATION LAWS. MINIMUM 24 HOUR ADVANCE NOTI E REQUIRED FOR INSPECTIONS -jPLEASE CALL (209) 953-769�/7 /�j SIGNED ' G TITLE J1✓>�i17`r»- DATE � lG !(O Application Accepted X Final Inspection ByQ�G Character of Soil to Depth of 3 COMMENTS INI S TMENT S LY Date / Area Employee ID#� Date SPE IAL ERMIT - Approved by Pit/Sump Soil Character: PE Code SC INFO Received BY heck as Amount Remitted Date Permit/ Service Request # Invoice # Permit ID# 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 5/5/17 U