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ONSITE WASTEWATER TREA'FMENT SYSTEM PERMIT P- SA%JOAOUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 'ANON -REFUNDABLE PERMIT ALL (209),953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED -- _ Jou ADDRESSCITY/ZIP %CR0*S STREET APN TIT _-�o r PA S IZE OWNER NAMEAr(P�gz PHO;D Z OWI:�R ADDRESS06&A.� CONTRACTORlA f � _ _ _ PHONE CONTRACTOR ADDRESS CITY/STATE/ZIP LICENSE ❑ ❑C-42 F-1, C-36 OTHER NUMBER EXPIRATION DATE C— WATER TABLE DEPTH: L f 9 ft GEOGRAPHICAL INFORMATION: Coordinates X Y J PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # TYPE OF WORK: I NEW INSTALL ATION REPAIR/ADDITION ENGINEEr. DESIGNED/ALTERNATIVE REPLACEMENT'S OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION ' INSTALLATION WILL ERVE: IV RESIDENCE ❑ COMMERCIAL� ❑ OTHER Z+ NUMBER OF LIVING UNITS: I NUMBER OF BEDROOMS: l NUMBER OF EMPLOYEES: SEPTICTANK TYPE/MFG ! CAPACITY _ (QRZ— gal # OF COMPARTMENTS �Z-- /❑ GREASE TRAP TYPE/MFG _ _ CAPACITY gal # OF COMPARTMENTS DISTANCE TO NEAREST: WELL i 00 . _ _ _ It FOUNDATION .__—tA4_ ft PROPERTY LINE ZC) ft ❑ LIFT STATION SIZE TYPE OF PUMP _ ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) �T LEACH LINES ❑ LEACHING CHAMBERS # OF LINES_ LENGTH OF LINES /� 5 ft DISTANCE TO NEAREST WELL ft FOUNDATION 1, l�fi It PROPERTY LINE 2t/ 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 WIDTH DEPTH f, ft DISTANCE TO NEAREST WE O ft PROPERTY LINE ft ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft DISTANCE To NEAREST WELL ft FOUND/9TION ft PROPERTY LINE It SEEPAGE PITS NUMBER WIDTH_ ! :I�N ft DEPTH Z7�T ft DISTANCE TO NEAREST WELL 5'0 _ ft FOUNDATION 1 D 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. MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLF_ASE CALL 209 953-7697 SIGNED/", --- TITLE 4vi-M^ ' DATE / _3 / — ( S DEPARTMENT USE O LY Application Accepted Byte_ reEmployee ID# Final Inspection By / ` to5�J •SPECIPL PE !".IT - Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Sgilr aracter: COMMENTS k4Z)46&VYLE \ . n I ITWa �— 'Tr1V1 2e itJ UVI PE Code SC INFO Received Check#/ By Cash Amount Date Remitted Permit/ Service Re uest # Invoice # Permit ID# It 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 5/5/17