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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT P/' SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 NON-REFUNDABLE PERMIT CALL209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS (J CITY/ZIP �j � u CROSS STREET 9`-SC��JLO��%//� APN Z r v — ' / 0 PARCEL SIZE OWNER NAME i M- 1 v l�%'rI r.7 PHONE OWNER ADDRESS `�i/J/[/ f CITY/STATE/ZIP CONTRACTOR 't PHONE CONTRACTOR ADDRESS / / / i /'�� ^ ----CITY/STATE/ZIP LICENSE I I C-42 I I C-36 OTHER NUMBER VT EXPIRATION DATE WATER TABLE DEPTH: / O ft GEOGRAPHICAL INFORMATION: Coordinates X Y J PERC TEST # BUILDING PERMIT # O LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT 0z OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: er RESIDENCE 11 COMMERCIAL I_ OTHER NUMBER OF LIVING UNITS: �D/ J/I V l".Y�� NUMBER OF BEDROOMS: _ NUMBER OF EMPLOYEES: SEPTIC TANK TYPE/MFG i�G �'��rACI�L CAPACITY G% gal # OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS f � DISTANCE TO NEAREST: WELL /Irz) ft FOUNDATION ft PROPERTY LINE .3 C3 ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) 19 LEACH LINES LEACHING CHAMBERS # OF LINES rJ LENGTH OF LINES SIGNED Application Accepted 9y_ Final Inspection By p/A Character of Soil to Depth COMMENTS ADVANCE NOTICE REQUIRED FOR INSPPE�CTION-S` - PLEASE CALL / TITLE C� �+� �l a� DATE C--/ G / Is ft ft ft ft ft ft ft ft ft ft ft r/94 -0 PARTMENT 11SEANsk Y Date—q— Area Employee ID#CJS Lino ?1A4 aAn llili)hili? Date�Ei SPECIAL PERMIT -Approved by 11FtPit/Sump Soil Character: _ PE Code SC INFO Received By DISTANCE TO NEAREST WELL 00 ft FOUNDATION ft PROPERTY LINE ❑ FILTER BED WIDTH ft LENGTH ft DEPTH DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ❑ MOUNDED WIDTH ft LENGTH ft DEPTH DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE l � :1111) SUMPS % / WIDTH ! ft LENGTH �7 ft DEPTH / DISTANCE TO NEAREST WELL /S'a7 ft FOUNDATION _ * ft PROPERTY LINE S ❑ DISPOSAL PONDS WIDTH ft LENGTH 7/cam ft DEPTH DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE 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 Application Accepted 9y_ Final Inspection By p/A Character of Soil to Depth COMMENTS ADVANCE NOTICE REQUIRED FOR INSPPE�CTION-S` - PLEASE CALL / TITLE C� �+� �l a� DATE C--/ G / Is ft ft ft ft ft ft ft ft ft ft ft r/94 -0 PARTMENT 11SEANsk Y Date—q— Area Employee ID#CJS Lino ?1A4 aAn llili)hili? Date�Ei SPECIAL PERMIT -Approved by 11FtPit/Sump Soil Character: _ PE Code SC INFO Received By Check#/ Amount Cash Remitted Date Permit/ Service Request # Invoice # Permit ID# 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 5/5/17 f1 m Y O 0 n