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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 NON-REFUNDABLE PERMIT CALL1209) 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS I / --wO __> 0 CROSS STREET OWNER NAME OWNER ADDRESS �_ V�Xoo' CITY/ZIP ,��JOi L A P N Zq-47 PARCEL SIZE V CONTRACTOR JS L1il`�1�CvC'�Icl� CONTRACTOR ADDRES Py LICENSE I I C-42 C-36 OTHER NUMBER PHONE / CITY/STATE/ZIPI' PHONE —CITY/STATE/ZIP E�xi16-rave—C I EXPIRATION DATE q/30 ( X06 WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y LI PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION / ENGINEER DESIGNED /ALTERNATIVE REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM X DESTRUCTION rw#VK INSTALLATION WILL SERVE: ! I RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPE/MFG ❑ GREASE TRAP TYPE/MFG DISTANCE TO NEAREST: WELL ❑ LIFT STATION SIZE TYPE OF PUMP ❑ LEACH LINES LEACHING CHAMBERS CAPACITY CAPACITY ft FOUNDATION ❑ PKG TX PLANT gal # OF COMPARTMENTS gal # OF COMPARTMENTS ft PROPERTY LINE ft ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) # OF LINES LENGTH OF LINES M 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 Application Accepted By Final Inspection By 1j - Character of Soil to Depth of 3 Ft: COMMENTS vrr 11VOr-Cl, r rvrvO - VLMMOC t,141 -L fc11Jy1 ZI TITLE / /�C9&'WT DATE 311 TM E N Th S E Y Date /-- -� — Area Employee ID#� Date 7 17 �_ _ _1 SPECIAL PERMIT - Approved by PitJSump Soil Character: PE DISTANCE TO NEAREST WELL Check#/ ft FOUNDATION _ Permit/Code It PROPERTY LINE ft ❑ FILTER BED WIDTH ft LENGTH Remitted Date ft DEPTH ft DISTANCE TO NEAREST WELL 37 ft FOUNDATION Od 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 _ _ It 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 WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL WORKERS COMPENSATION LAWS. SIGNED Application Accepted By Final Inspection By 1j - Character of Soil to Depth of 3 Ft: COMMENTS vrr 11VOr-Cl, r rvrvO - VLMMOC t,141 -L fc11Jy1 ZI TITLE / /�C9&'WT DATE 311 TM E N Th S E Y Date /-- -� — Area Employee ID#� Date 7 17 �_ _ _1 SPECIAL PERMIT - Approved by PitJSump Soil Character: PE SC Received Check#/ Amount Permit/Code INFO B Cash Remitted Date Service Request # Invoice # Permit ID# 37 3 Od 42-U1 5/5/17 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT m Y 0 v