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a3, 4.6 ONSITE WASTEWATER TREATMENT SYSTEM PERMIT /D f' SAN JOAQUIN 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 {i` CITY/ZIP -L L CROSS STREETS APNPARCEL SIZE 1 OWNERNAME I' •O^JL� . � + '� t;eS!9--e-L ]]// PHONEJ OWNER ADDRESS ce iS Tel 4 S DC ITY/STATE/ZIP CONTRACTOR try t� S �Lj �� h X-0— �e a- . PHONE L7—��[LO`- 5 CONTRACTOR ADDRESS 16.. )c I/�O CITY/STATE/ZIP ��I � fA- q4 d' 33, s LICENSE I I C-42 I I C-36 OTHER 1 NUMBER EXPIRATION DATE ti FK� WATER TABLE DEPTH: %V ft GEOGRAPHICAL INFORMATION: Coordinates X Y IJ PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: L.-<ESIDENCE Ll COMMERCIAL I_, OTHER NUMBER OF LIVING UNITS: I NUMBER OF BEDROOMS: .2 NUMBER OF EMPLOYEES: LLi,,- SEPTIC TANK TYPE/MFG 'Z CAPACITY Nlm' gal # OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS DEPTH ft DISTANCE TO NEAREST: WELL 160, ft FOUNDATION ft PROPERTY LINE S, ft ❑ LIFT STATION SIZE TYPE OF PUMP_ —_ ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) LEACH LINES LEACHING CHAMBERS # OF LINES _ f LENGTH OF LINES C / ft DISTANCE TO NEAREST WELL 1 W- ft FOUNDATION Io ' ft PROPERTY LINE �t ft ❑ FILTER BED WIDTH Received By ft LENGTH Date Permit/ Service Request # Invoice # ft DEPTH ft C DISTANCE TO NEAREST WELL s�a 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 /�//ww DEPTH Cplljf.._ ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LIN WC11 It ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH MA O 3 ')n ft DISTANCE TO NEAREST WELL ft FOUNDATION ems,. ft PROPER I` 4&Ij� V I ft El SEEPAGE PITS NUMBER WIDTH ft DEPTH urfRoti.. COUNTv ft �c DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE111 OEPART.; 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. SIGNED �ti TITLE G0^*!P-CA4(- DATE _'T Character of Soil to Depth of 3 Ft: COMMENTS Pit/Sump Soil Character: Approved by PE Code SC INFO Received By heck s Amount Remitted Date Permit/ Service Request # Invoice # Permit ID# 411711 C 1 s�a 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 5/5/17