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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT �{S.AN 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 1JOB ADDRESS 310 12----CITY/ZIPd -L CROSS STREET �L y YO r - iz�c O 1J� Y�(/�Wl APN �r PARCEL SIZE OWNER NAME ISO-V-TV]Inn 14 1 of 7 PHONE -209 - 4.0 9' 711-D'ts OWNER ADDRESS Ap 3I6LIO +��JI rjS rrv... CITY/STATE/ZIP MCC�ui_',� CIq - -953014 ' CONTRACTOR _rv2 Cc"n L'X-:fi� n /; iy-, PHONE 2t/ 1 -%!7 - 172 5 CONTRACTOR ADDRESS IB_5-M Akr' d,%g a Kd. CITY/STATE/ZIP �T/G!L✓ e -A 16-50 4 LICENSE ❑OC -42 I I C-36 OTHER tJ NUMBER-5-�H -2_,�;7 EXPIRATION DATE ZC% WATER TABLE DEPTH: bID L , ft GEOGRAPHICAL INFORMA LI PERC TEST # BUILDING PERMIT # TYPE OF WORK: NEW INSTALLATION REPAIF Coordinates X Y AND USE APPLICATION # )N ENGINEER DESIGNED REPLACEME T OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: /J RESIDENCE [] COMMERCIAL NUMBER OF LIVING UNITS:y NUMBER OF BEDROOMS: � SEPTIC TANK (❑ GREASE TRAP ❑ LIFT STATION LL OTHER NUMBER OF EMPLOYEES: TERNATIVE TYPE/MFG Y' L LAncd--eA. CAPACITY 1 Sd b gal # OF COMPARTMENTS Z TYPE/MFG CAPACITY gal # OF COMPARTMENTS DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) $ LEACH LINES -)C- LEACHING CHAMBERS C Q Z`I Chec ash # OF LINES__ Date DISTANCE TO NEAREST WELL Permit ID# ft FOUNDATION ❑ FILTER BED WIDTH ft LENGTH y ft DISTANCE TO NEAREST WELL ft FOUNDATION ❑ MOUNDED WIDTH ft LENGTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ❑ SUMPS WIDTH ft LENGTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ❑ SEEPAGE PITS NUMBER WIDTH ft DISTANCE TO NEAREST W ELL ft FOUNDATION LENGTH OF LINES /Ge ft ft PROPERTY LINE ft DEPTH ft It PROPERTY LINE ft DEPTH ft ft PROPERTY LINE ft DEPTH w ft ft PROPERTY LINE ]� ft DEPTH vp�/► V ft ft PROPERTY LINEJUL // i 9n._ ft DEPTH %-10" ._ _ ft ft PROPERT ' &0M C,U(�y ft I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE AMWMN 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 e Application Accepted B r Final Inspection By Character of Soil to Depth of 3 Ft: COMMENTS Date Date FOR INSPECTIONS - TITLE Uwyl,G-✓ DATE `I Z - J$ IS N Y i Area Employee ID# s n SPECIAL PERMIT - Approved by Pit/Sump Soil Character: PE Code SC INFO Received B Chec ash Amount Remitted Date Permit/ Service Request # Invoice # Permit ID# y 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 5/5/17