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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 IVUN-ntrurvUACLt rtHMI I SC INFO GALL (ZU-9) JbJ-1b.91 FOR INSPECTIONS 1 YEAR FROM DATE ISSUE JOB ADDRESS ^- ,��EX[PI-RES 4.�'/ ' CITY/ZIP 1 OC mil Git Permit/ Service Request # CROSS STREET ��j',G/� Sj ^ APN43 '_� V PARCEL SIZE J y2 i OWNER NAME !�� 4 LJ(/�`TV�/ _ _ _ _ PHONE OWNER ADDRESS a�M y CITY/STATE/ZIP CONTRACTOR �� /� OS� � � _-- PHONE 'L .4;&_�7�SV.'J"� CONTRACTOR ADDRESS scyea tY�V CITY/STATE/ZIP �C%�J/`�y�7'��✓t !j � LICENSE I C-42 I I C-36 OTHER NUMBER &685sq EXPIRATION DATE 0 1 � WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y LI PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # Am TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION -i ENGINEER DESIGNE � 71 REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM J DESTRUCTION INSTALLATION WILL SERVE: j ESIDENCE Ll COMMERCIAL LI OTHER AM 7 NUMBER OF LIVING UNITS: 1 NUMBER OF BEDROOMS: NUMBER OF EMPLO I�,I� �g ❑ SEPTIC TANK TYPE/MFG CAPACITY gal # OF COMP Fly nr,)-,,�NCO—_- U/j/ ❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENT$E�7 . DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PK.G TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) ..... .._ UleoL*EACH LINES LEACHING CHAMBERS # OF LINES i LENGTH OF LINES Loll ft DISTANCE TO NEAREST WELL 1561- ft FOUNDATION I ft PROPERTY LINE �t�� 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 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 LINE ft SEEPAGE PITS NUMBER d- WIDTH 319 $I ft DEPTH 9S7, ft DISTANCE TO NEAREST WELL l .4!;n, ft FOUNDATION Ja, ft PROPERTY LINE ft I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL WORKERS COMPENSAIION LAWS. MINIMUA HO R ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 SIGNEDA*bV=7M--;ft__ TITLE C�$-r1t9w,&ar DATE 1-�- Application Accepted B Final Inspection By Character of Soil to Depth of 3 Ft: COMMENTS Area Employee ID# 11SPE IAL PERMIT -Approved by Pit/Sump Soil Character: PE Code SC INFO Received B he ash Amount Remitted Date Permit/ Service Request # Invoice # Permit ID# J y2 i SP007qoq 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 5/5/17