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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT P1 1 SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 NON-REFUNDABLE PERMIT GALL ZU9 953-7697 FOR INSPECTIONS EXPIR,ES,/�1 YEAR FROM DATE ISSUEI JOB ADDRESS I / O w/ _ r n r L A CIIT/YIZIP L C�)' 1 �-✓� q CROSS STREET InXj Lia u�t,S # OF COMPARTMENTS �!�, /al1� APN d S D VL�7 ( � PARCEL SIZE / V ' OWNER NAME U b ne yord LL PHONE ❑ LIFT STATION 0 P (L U, �� 2 OWNER ADDRESS A CITY/STATE/ZIP V' p� T - CONTRACTOR M 1u.G ft LENGTH PHONE CONTRACTOR ADDRESS d'i L , C , c� CITY/STATE/ZIP Y/ M Ic�'yt 1 C:-4 LICENSE I I C-42 11 C-36 OTHER A NUMBER(V-a8'5SVEXPIRATION DATE '1 WATER TABLE DEPTH: ,.5� ft GEOGRAPHICAL INFORMATION: PERC TEST # BUILDING PERMIT # P - TYPE OF WORK: NEW INSTALLATION REPAIR/ADE Coordinates X Y f,L� LAND USE APPLICATION # IN ENGINEER DESA REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION NED/ALTERNATIVE INSTALLATION WILL SERVE: ESIDENCE ❑ COMMERCIAL OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: 01"'S EPTIC TANK TYPE/MFG L+ CAPACITY to njo — gal # OF COMPARTMENTS_ ❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS ft DEPTH ft DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) , LEACH LINES LEACHING CHAMBERS 1 # of LINES LENGTH OF LINES Chec ash DISTANCE TO NEAREST WELL 1.149 ft FOUNDATION 10 t ft PROPERTY LINE ft ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL �® ft FOUNDATION ft PROPERTY LINE Eluirt AN ❑ MOUNDED WIDTH ft LENGTH ft DEPTH RECr_I1/ ..ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ SUMPS WIDTH ft LENGTH ft DEPTH Y aft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LI ft E3DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ENVI '"� UNTyr DISTANCE TO NEAREST WELL N ft FOUNDATION ft PHOPERT; LRVF-ALTH DEPART. L I W SEEPAGE PITS NUMBER WIDTH 3to n ft DEPTH S ft DISTANCE TO NEAREST WELL If Gal It FOUNDATION i'St 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 COMPENSATION LAWS. SIGNED Application Accepted B Final Inspection By —Vv Character of Soil to Depth of 3 Ft: COMMENTS ' r .!- �Y✓ r L V - PLEASE CALL TITLE DATE DEPARTMENT USE ONLY Date • a- -1 Area _ Employee ID# O n Date 1 IM❑ SPECIAL PERMIT - Approved by Pit/Sump Soil Character: i 55urd 20A (Se I bar /LS) 0 NW,AUNIM� PE Code SC INFO Received B Chec ash Amount Remitted Date Permit/ Service Request # Invoice # Permit ID# yap) v )I 15— 2� 3 YSP—M-79i4 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 5/5/17