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lb ONSITE WASTEWATER TREATMENT SYSTEM PERMIT 15 SAN JOAQUII`,COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 NOM -REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS n EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS r 1 '` l _ CITY IP /„fit %, CROS STREET bull ' ave rt a VIN APN �� I �%' PARCEL SIZE O`VNERNAME 1 �R� PHONE /G�-j—c,-22-j OWNER ADDRESS I ( � �10 S t''Z- `� r1TV/STATF/71P CONTRACTOR ow %,) ea- PHONE CONTRACTOR ADDRESS LICENSE I C-42 ❑ C-36 OTHER CITY/STATE/ZIP NUMBER EXPIRATION DATE WATER TABLE DEPTH: �[/ J ft GEOGRAPHICAL INFORMATION: Coordinates X Y FJ PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION PAIR/ADDITIONIt ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: RESIDENCE I COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: ?�(/D NLLMBER OF BEDROOMS: _ I NUMBER OF EMPLOYEES: 0 Application Accepted gy Final Inspection By Character of Soil to Depth of 3 COMMENTS " W4 -rw TMENT Date I Area Employee ID# Date ❑ SPECIAL PERMIT - Approved by Pit/Sump Soil Character: 4 l u % 1 Sr• N.[ n'iS` d y ll 6 r .a cL , t wao 6k c4i- PE Code ex n'll ell Jr# L 0 Received By-, SEPTIC TANK TYPE/MFG CAPACITY gal # OF COMPARTMENTS — D t ❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS Permit ID# /L�DO DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) d LEACH LINES LEACHING CHAMBERS# OF LINES � LENGTH OF LINES / c.7 ft f1 t DISTANCE TO NEAREST WELL-( U ft FOUNDATION ft PROPERTY LINE ft ❑ FILTER BED WIDTH ft LENGTH ft DEPTH N 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 WIDTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION 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 COMPEN T(ON LAWS. MINIMUM HOU/R A VAIVCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL 209 9.53-7697 C 4- �� (� �V SIGNED r �' ./!!. ! TITLE DATE iZlz o 0 Application Accepted gy Final Inspection By Character of Soil to Depth of 3 COMMENTS " W4 -rw TMENT Date I Area Employee ID# Date ❑ SPECIAL PERMIT - Approved by Pit/Sump Soil Character: 4 l u % 1 Sr• N.[ n'iS` d y ll 6 r .a cL , t wao 6k c4i- PE Code SC INFO Received By-, hec Amount Remitteg D t Permit/ Service Request # Invoice # Permit ID# s f -W79aD 1 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 5/5/17