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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT ,/I SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 I1UN-11trUNUA13Lt PERMIT GALL (209) 553-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUE JOB ADDRESS -' � TYPE/MFG �}-� CAPACITY � r5�_ -,)•y��J �� ' _ CITY/ZIP ft LENGTH CR091 STREET %(i/ D DEPTH ft APN �j O �02. PARCEL SIZE O• OWER NAME/�F! i►(J�QQ� VFX PHONE OWNER ADDRESS t� r ` C;ITY/STATE/ZIP / CONTRACTOR C & �r b PHONE (! FOUNDATION CONTRACTOR ADDRESS G r• CITY/STATE/ZIP lL! LICENSE I ; C-42 I 1 C-36 OTHER 0_ NUMBER (1209� EXPIRATION DATE WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y 11 PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT OUT -O -SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: LL RESIDENCE _ COMMERCIAL LL OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: TANK TYPE/MFG CAPACITY gal # OF COMPARTMENTS �IC GREASE TRAP TYPE/MFG �}-� CAPACITY � r5�_ gal # OF COMPARTMENTS_ {� WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST DISTANCE TO NEAREST: WELL 10 D� ft FOUNDATION ft PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) 117 LEACH LINES LEACHING CHAMBERS # OF LINES LENGTH OF LINES f ft Date DISTANCE TO NEAREST WELL 1 ��t ft LL� FOUNDATION J'�1 ft PROPERTY LINE r 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 ftl tFOUNDATION ft PROPERTY LINE ft SEEPAGE PITS NUMBER WIDTH S � ft DEPTH 5S ft -? DISTANCE TO NEAREST WELL I �i 7, ft FOUNDATION 70 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. ADVA SIGNED Application Accepted By '7,�((f Final Inspection By� Character of Soil to Depth of 3 Ft: COMMENTS 9k- Z� , 'OR INSPECTIONS - PLEASE CALL 209 953-7607 TITLE 4f0lT'* f-^ CIA- T DATE c r M" r IVI C rY r • Date Area ' � Employee ID# A"%P Date1/ 1J /_ SPECIAL PERMIT - Approved by Pit/Sump Soil Character: 4L?f lJC rT� ZY/4726. x" /, /'�i,u/U.b vx-/, PE Code SC INFO Received B Check Amount as Remitte Date Permit/ Service Request # Invoice # Permit ID# 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 5/5/17