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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT PZ 1 SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 NON-HEFUNDABLE PERMIT L:ALL LU9 9b3-169/FOR INSPECTIONS XPIRES 7 YEAR FROM DATE ISSUEI JOB ADDRESS DISTANCE TO NEAREST CITY/ZIP _ ft FILTER BED WIDTH _ _ -7/'d f �f /� Z, LENGTH CROSS STREET lf'��Sl�1'� _ _ APN !J�! �/`� y PARCEL SIZE V MOUNDED WIDTH ft ?:� UT OWNER NAME l � 11 WELL , _ P{HOONNEE� SUMPS % % 4 W NP // OWNER ADDRESS / ✓1 CITY/STATE/ZIP CONTRACTOR /\ %- /J%,�.t�jl�y��}�� ✓ll/�/� PHONE �.S LENGTH CONTRACTOR ADDRESS �L� 1!� —CITY/STATE/ZIP SEEPAGE PITS NUMBER � LICENSE ❑ C-42 ❑❑C-36 OTHER NUMBER 0 EXPIRATION DATE__ is: WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # TYPE OF WORK: I NEW INSTALLATION L I REPAIR/ADDITION L ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT 1 OUT -OF -SERVICE SEPTIC SYSTEM ik—' DESTRUCTION X,6,r INSTALLATION WILL SERVE: D$ESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: ,)— NUMBER OF BEDROOMS: 2�_ NUMBER OF EMPLOYEES: ❑ SEPTIC TANK U GREASE TRAP ❑ LIFT STATION TYPE/MFG TYPE/MFG DISTANCE TO NEAREST: WELL SIZE TYPE OF PUMP LEACH LINES LEACHING CHAMBERS ft FOUNDATION DISTANCE TO NEAREST WELL _ ft FILTER BED WIDTH _ _ ft LENGTH FOUNDATION DISTANCE TO NEAREST WELL MOUNDED WIDTH ft LENGTH DISTANCE TO NEAREST WELL SUMPS WIDTH ft LENGTH DISTANCE TO NEAREST WELL DISPOSAL PONDS WIDTH ft LENGTH DISTANCE TO NEAREST WELL SEEPAGE PITS NUMBER WIDTH— DISTANCE TO NEAREST WELL CAPACITY CAPACITY ft FOUNDATION _ ❑ PKG TX PLANT gal # OF COMPARTMENTS gal # OF COMPARTMENTS ft PROPERTY LINE ft ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) LENGTH OF LINES ft ft PROPERTY LINE ft ft DEPTH ft ft PROPERTY LINE ft ft DEPTH ft ft PROPERTY 1, ft ft DEPTH ft ft PROPERTY ft ft DEPTH n. _ O�y ft ft PROPER 4uw couivry ft ft DEPTH 11E4l7N r�A;' 7eft ft PROPERTY LINE "MEN 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. MINIKM 24 HOUR AQVANCIF NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL 209 953-7697 SIGNED TITLEDATE Application Accepted By Final Inspection By Character of Soil to Dept of 3 COMM -:NTS • DEPARTMENT USEO Y DateArea Employee ID#� Date— _ ❑ SPEC AL PERMIT - Approved by Pit/Sumo Soil Character: PE ode # OF LINES ft FOUNDATION _ It FOUNDATION _ ft FOUNDATION ft FOUNDATION ft FOUNDATION _ ft FOUNDATION gal # OF COMPARTMENTS gal # OF COMPARTMENTS ft PROPERTY LINE ft ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) LENGTH OF LINES ft ft PROPERTY LINE ft ft DEPTH ft ft PROPERTY LINE ft ft DEPTH ft ft PROPERTY 1, ft ft DEPTH ft ft PROPERTY ft ft DEPTH n. _ O�y ft ft PROPER 4uw couivry ft ft DEPTH 11E4l7N r�A;' 7eft ft PROPERTY LINE "MEN 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. MINIKM 24 HOUR AQVANCIF NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL 209 953-7697 SIGNED TITLEDATE Application Accepted By Final Inspection By Character of Soil to Dept of 3 COMM -:NTS • DEPARTMENT USEO Y DateArea Employee ID#� Date— _ ❑ SPEC AL PERMIT - Approved by Pit/Sumo Soil Character: PE ode SC INFO Receiv Chec ash Amount Remitted Permit/ Date Service Request # Invoice # Permit ID# �S&^rtao�go�� 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 5/5/17