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t ONSITE WASTEWATER TREATMENT SYSTEM PERMIT S,'N JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS XPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS 0 L CITY/ZIP - + q T CROSS STREET � APN C� 2-11 O .J�� l� PARCEL SIZE � v OWNER NAME —CIL M&Y— -pr;rk PHONE --&49-8990 CA OWNER ADDRESS S (� bDy CITY/STATE/ZIP CONTRACTOR_ PHONE CONTRACTOR ADDRESS CITY/STATE/ZIP LICENSE 11 C-42 I I C-36 OTHER NUMBER EXPIRATION DATE WATER TABLE DEPTH: 4-5 ' ft GEOGRAPHICAL INFORMATION: Coordinates X Y Ll PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: I NEW INSTALLATION ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT r OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: ';fi, RESIDENCE ❑ COMMERCIAL ❑ THER NUMBER OF LIVING UNITS: I'1 NUMBER OF BEDROOMS: a NUMBER OF EMPLOYEES: �l- Id SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS v j❑`GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS DISTANCE To NEAREST: WELL �� ft FOUNDATION ft PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT O SAND OIL SEPARATOR(ENCLOSED SYSTEM) LEACH LINES LEACHING CHAMBERS _ #OF LINES J� LENGTH OF LINES ft DISTANCE To NEAREST WELL ft FOUNDATION /(/ It PROPERTY LINE of 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 ft FOUND TION ft PROPERTY LINE ft SEEPAGE PITS NUMBER -21ft DEPTH 2 ft WIDTH � DISTANCE TO NEAREST WELL--I__TQ ft FOUNDATION ft PROPERTY LINE S 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 COMPENS/IION LAWS. 1/63 MINIMyM,j-jfHOyX ADVANCE NOTICE REQUIRED FOR 1NSPEC l S-PLEASE CALL 209 953-7697 SIGNE TITLE jpft r. DAT C�, r c SN O NTL p PAI T 01000 1A, J 1ADEPARTMENT USE ONLY 1 , Application Accepted EIV Date Area Employee ID# W Final Inspection By d Date ILI k) 14e ❑ SPECIAL PERMIT-Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Char a ter: COMME TS k xea -+Yriez • ay oldb�� 2 r PE SC Received Check#/ Amount Permit/ Code INFO By— Cash Remitted Date Service Request# Invoice# Permit IDif� l 4J 6101-ISA 42.01 ��l U ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 5/5/17 Old s� �K ��strr�cod o r� s.�u-.