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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-P1thUNUAt3Lk t'EHMII L:ALL fZU9J 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUEI JOB ADDRESS JJVU",`:� rlZ • CITY/ZIIP CROSS STREET D jr-' ), .1� �U - APN �� I �I � )S PARCEL SIZES ! • OWNER NAME lt1 54 L PHONE �ii� j� �-1 `tel e OWNER ADDRESS CITY/STATE/ZIP CONTRACTOR — PHONEQn l�� I -3) 3 :7 ! OZS CONTRACTOR ADDRESS U CITY/STATE/ZIP Z�"/y, Pc4n I 3 Vhf/ LICENSE I J C-42 I I, -C-36 OTHER NUMBER EXPIRATION DATE .,�! IZ? q 1 9 WATER TABLE DEPTH: "'� I U U ft GEOGRAPHICAL INFORMATION: Coordinates X Y D PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION 1 REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT I OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: RESIDENCE L COMMERCIAL L1 OTHER NUMBER OF LIVING UNITS: I NUMBER OF BEDROOMS: _ NUMBER OF EMPLOYEES: XSEPTIC TANK TYPE/MFG +- L _ CAPACITY J(P, UL gal # OF COMPARTMENTS—2 ❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS DISTANCE TO NEAREST WELL ft DISTANCE TO NEAREST: WELL 2 w ft FOUNDATION f4- ft PROPERTY LINE 2 0 -�" ft ❑ LIFT STATION SIZE TYPE OF PUMP P ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) LEACH LINES LEACHING CHAMBERS # OF LINES LENGTH OF LINES 9S ft ash DISTANCE TO NEAREST WELL�E� ft FOUNDATION ' S �' ft PROPERTY LINE 3 U ft ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft 9)1 n DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft IK 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 WIDTH41 DEPTH ft DISTANCE TO NEAREST WELL iG04- ft FOUNDATION r1 Z, % ft PROPERTY LINE Z i, > 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 4+13 LAWS. MINIMUM PXHOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL 209 953-7769`7 SIGNEDLwqi � TITLE C71.?,YIf�V DATE L- —I2�i Application Accepted By Final Inspection By Character of Soil to Depth of 3 Ft: COMMENTS %- 4,1/0IZ DEPARTMENT USE ONLY q SANJOA%LnM&� IAIA Date �' Area Employe V 1'A Date 11SPECIAL PERMIT - Approved by -NT it/Sump Soil Character: o`� r"'� I PE Code SC INFO Received(Check B ash Amount Remitted Date Permit/ Service Request # Invoice # Permit ID# 9)1 n 11 7' (.d -1'7q3 I 30 i2' IK 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 5/5/17