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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT elr SAN JOAOUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 N'ON-REFUNDABLE PERMIT Sy CALL 209 953-7697 FOR INSPECTIONS c EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS M L. -7 l' Y /_��CfITY/ZIP CROSS STREET �' �Ci� 1` �'i�i i APN � ,V`D PARCEL SIZE �j v OWNER NAME ��f� I, 11 t�iC�� r� 4- CJ t'I( PHONE OWNER ADDRESS `7 / CITY/STATE/ZIJP� (/ CONTRACTOR `(��_ CCI�r1 -jK. ��% _ PHONE CONTRACTOR ADDRESS 61iC ll� �� 0 _CITY/STATE/ZIP_vekf . cv� LICENSE I C-42 1 I C-36 OTHER- NUMBER CP20QZLtEXPIRATION DATE_�� 1 WATER TABLE DEPTH: .0 ft GEOGRAPHICAL INFORMATION: Coordinates X Y PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION ❑ SEPTIC TANK TYPE/MFG CAPACITY gal # OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS Permit ID# DISTANCE TO NEAREST: WELL ft FOUNDATION It PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) -----------._--- ___ ..._..... _............._ -__ _ _ __.. ____-. ___. _ ._ ...._.--_ . __... . _...... ..._..._ _ _ _. _ _. _ _..,___.�,._ LEACH LINES LEACHING CHAMBERSq� # OF LINES LENGTH OF LINES i(0 ft DISTANCE TO NEAREST WELL�_yr_��_ ft FOUNDATION Irl ft PROPERTY LINE ft ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE It ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL It 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 It DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft �� fid SEEPAGE PITS NUMBER 2L WIDTH 3(v ft DEPTH �i ft DISTANCE TO NEAREST WELL trio It e FOUNDATION 10 t ft PROPERTY LINE It 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 1 Al1 _ TITLE 6-0 A If (�_ -)(S f DATE - / / 7( Application Accepted /B� Final Inspection By .NQ-22fi� Character of Soil to Depth of 3 Ft: COMMENTS IS v Y Area Employee ID# PF ❑ SPECIAL PERMIT - Approved by Pit/Sump Soil Character: PE Code SC INFO Received B Check#/ Cash Amount emitted Date Permit/ Service Request # Invoice # Permit ID# 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 5/5/17