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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT �fv 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 � 8Q 6-6 O eo L) - • _C>ITYRIP 61 CN f Z [i CROSS STREET H� %� �G,,� ) APN �%�Aj — ?a - / (� PARCEL SIZE OWNER NAME (�fJJ/JZQ 7 E��//F'%�/ ti 11Gr"} "jq _ PHONE! OWNER ADDRESS `f L_ I �O-Pflq �� ___CITY/STATE/ZIP bcp w' .Z z CONTRACTOR Ce -1 � • q I * I tM 9 4 -ei2- _ _ PHONE o�Cp/y - �� "/ ICONTRACTOR ADDRESS C;—L3/ (y 1 O S�� r _ CITY/STATE/ZIP �L( .,, LICENSE I I /V-42 I I C-36 OTHER NUMBER I�O. ✓ EXPIRATION DATE 1 --?;0 ' ` I WATER TABLE DEPTH: W -� tT/ U ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION R PAIR/ DDITION I ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: RESIDENCE Li COMMERCIAL J OTHER NUMBER OF LIVING UNITS: I NUMBER OF BEDROOMS: 4 NUMBER OF EMPLOYEES: SEPTIC TANK TYPE/MFG p* L CAPACITY &,-00 gal # OF COMPARTMENTS — ❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS DISTANCE TO NEAREST: WELL 000 ft FOUNDATION 15- ft PROPERTY LINE /00 Ir ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) ___._._ __.._._.__._..... ---- 11Q LEACH LINES LEACHING CHAMBERS _ # OF LINES 3 LENGTH OF LINES CJS It I DISTANCE TO NEAREST WELL OO ft FOUNDATION (fje6 , ft PROPERTY LINE ft ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft 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 It 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 1 SEEPAGE PITS NUMBER 3 WIDTH 4�6' / It DEPTH :;?S / It DISTANCE TO NEAREST WELL o-200 ft FOUNDATION CKJ If ft PROPERTY LINE CQ D 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 COMPENSAT ON LAWS. MINIMUM HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 SIGNED TITLE _ C��/i�riC�/� DATE -c?3 -/8 I I I I I I I I I I I I I I I I I I I I I EPARThIEN-TI-ISEE 96NLY PAYM� Application Accepted By1AIAAIDate Area R Final Inspection By Date ❑ SPEC AL PERMIT - Approve Character of Soil to Depth of 3 Ft: .vM- Pit/Sump Soil Character: ;� x7pll.; COMMENTS JOAQUIN COUNTY FWRDI'ditfig�T HEALTH AL DFCAn-.-_. _ PE SC INFO Received B ec Cash Amount emitted Date Permit/Code Service Request # Invoice # Permit ID# 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 5/5/17 Cr m Y 0 z r