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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT 0-- " SAN JOAOU,N COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 NON• REFUNDABLE PERMIT ALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUE[ JOB ADDRESS CITY/ZIP '5 c a L0� r 0 S3� CP.OSS STREET , nn APN _ oC 0,5 0 15 �% I U PARCEL SIZE 3. 0/ 7 OWNER NAME a kf`�� 19--cl �/1 PHONEY YV 0 C4zd62 UWNER ADDRESS 60S &'Quyyrk U _CITY/STATE/ZIP [` ipoy\ CONTRACTOR PHONE CONTRACTOR ADDRESS CITY/STATE/ZIP LICENSE I I C-42 I I C-36 OTHER NUMBER EXPIRATION DATE WATER TABLE DEPTH: SS ft GEOGRAPHICAL INFORMATION: 11 PERC TEST # BUILDING PERMIT # Coordinates X Y LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION ❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS Amount Remitted DISTANCE TO NEAREST: WELL �U ft FOUNDATION S ft PROPERTY LINE IL� + ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) LEACH LINES LEACHING CHAMBERS # OF LINES Ll LENGTH OF LINES O /� ,SDI TANCE TO NEAREST WELL Q-/ U ft FOUNDATIONy k ft PROPERTY LINE ❑ FILTER BED WIDTH f '� ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL` ft FOUNDATION — ft PROPERTY LINE dT 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 ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION 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 WITHH/ THECONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL COMPENSAJION woRKEMINIMUMHOIJR`I�VANCE ELCALIFORNIA �' NOTICE REQUIRED FOR INSPECTIONS -PLEASE CALL (209) 953-7697 SIGNED /' 0 V (i� _VJ '1 P ► TITLE __ 0DATE IG • � " y fkpplk�ation Aecarted Final Inspection By_ Character of Soil to D COMMENTS �� EPARTMENT USE ON Y V ` n.to _ G Fmnlnace I[1{1 — y' r-� P!c y - Date V 014_1 ❑ SPECIAL PERMIT - Approved by PitlSump Soil Character: 1 PE Code SC INFO Received Ch #/ B Cash Amount Remitted D to Permit/ Service Request # Invoice # Permit ID# r 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 5/5/17