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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 NUN-riEFUNDABLE VEHMIT (:ALL (ZU.9) yb3-/6y/ FOR INSPECTIONS tXPIRES 1 YEAR FROM DATE ISSUEI JOB ADDRESS D t C 370'E I';�!M ITY/ZIP CROSS STREET ^� -(JJ APN C� I 1 V PARCEL SIZE OWNER NAME %�IVi''oN IC7 ?0 - i'n PHONE OWNER ADDRESS // I)k1 // —" / CITY/STATE/ZIP CONTRACTOR G Q --,V T -N L // �/J%yC_ __. PHONE 36c/- TO- -7 CONTRACTOR ADDRESS �3�C. 0/sowT PX- CITY/STATE/ZIP ��" LICENSE I I )C-42 I I C-36 OTHER NUMBER VS70/S-EXPIRATION DATE Oct -.?U -1 S WATER TABLE DEPTH: ) 2 ft GEOGRAPHICAL INFORMATION: Coordinates X Y L I PERC TEST # BUILDING PERMIT # a LAND USE APPLICATION # TYPE OF WORK: pi- NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: RESIDENCE I j COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: V % NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: 0- ❑ ❑ SEPTIC TANK GREASE TRAP LIFT STATION TYPE/MFG IqL TYPE/MFG DISTANCE TO NEAREST: WELL It SIZE TYPE OF PUMP CAPACITY / Zw gal # OF COMPARTMENTS Z- CAPACITY gal # OF COMPARTMENTS FOUNDATION ft PROPERTY LINE ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) ft Date LEACH LINES LEACHING CHAMBERS Permit ID# ._---.... # OF LINES J LENGTH OF LINES y6 t ft �►-14 DISTANCE TO NEAREST WELL ft FOUNDATION Iy ft PROPERTY LINE S ' ft ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft 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 U — SEEPAGE PITS NUMBER 3 WIDTH vie #I ft DEPTH 25-' ft DISTANCE TO NEAREST WELL SO ft FOUNDATION So ft PROPERTY LINE S 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 COMPENSAIION LAWS. 549 MINI M HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 SIGNED TITLE DATE IY Application Accepted B Final Inspection By7A Character of Soil to Depth COMMENTS DEPARTMENT USE ONLY Date . -1 Area 1-� "1 Employee ID# Date E{ ❑ SPECIAL PERMIT - Approved by 3 Ft: Pit/Sump Soil Character: PE Code SC INFO Received By Check#/ Amount Remitted Date Permit/ Service Request # Invoice # Permit ID# J ass �►-14 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 5/5/17 T