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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT 1 4 SAN JOAOUIP COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 NON-REFUNDABLE PERMIT (:ALL 211Jy�-�953--7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUE joB ADDRESS /'��"�• CITY/ZIP ,� Q �% , CROSS STREET �Com_ / A�P+N�0�D�7 Oe _ 7 PARCEL SIZE _ 7 _/ OWNER NAME J /K/14SG0 J�eS1�CWGG / /��L/ f �I!/�C1U�/I� h ONE OWNER ADDRESS ?�// /�G�� JF��j�i /�� _ __CITY/STATE/ZIP / l� CONTRACTOR �GlfifC�1L 1,4AlfPHONE-Ii7"S-oZ + CONTRACTOR ADDRESS e, D� -CITY/STATE/ZIP LICENSE i P/ --A2 C-36 OTHER NUMBER Oy EXPIRATION DATE y 30 % S i 7 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. MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL 209 953-7697 SIGNED TITLE DATEZOIk Application Accepted B Final Inspection By Character of Soil to� COMMENTS IMtrvl u 5t LVIV Y Date Area Employee ID# , Date AWS ❑ SPECIAL PERMIT - Approved by Pit/Su p Soil Character: PE Code r Received B WATER TABLE DEPTH: I �� 3 0' ft GEOGRAPHICAL INFO MATION: ordinates X Y 11 PERC TEST # If ,C BUILDING PERMIT # LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION I REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT I OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: RESIDENCE _I COMMERCIAL L OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: 4 NUMBER OF EMPLOYEES: SEPTIC TANK / TYPE/MFG CAPACITY gal # OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS DISTANCE TO NEAREST: WELL Z�.iS r ft FOUNDATION iii ft PROPERTY LINE SO f— ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) Vi— LEACH LINES LEACHING CHAMBERS _ # OF LINES 3 LENGTH OF LINES �S ft DISTANCE TO NEAREST WELL ?Qn ft FOUNDATION �S , ft PROPERTY LINE `' ♦ 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 FOUNDATION ft PROPERTY LINE ft SEEPAGE PITS NUMBER 3 WIDTH y ft DEPTH ft �``. , DISTANCE TO NEAREST WELL rJ��CJ ft FOUNDATION 100 i ft r 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. MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL 209 953-7697 SIGNED TITLE DATEZOIk Application Accepted B Final Inspection By Character of Soil to� COMMENTS IMtrvl u 5t LVIV Y Date Area Employee ID# , Date AWS ❑ SPECIAL PERMIT - Approved by Pit/Su p Soil Character: PE Code Sc INFO Received B Chec ash Amount emi ed Da Permit/ Service Request # Invoice # Permit ID# 1 2281-1 VM S 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 5/5/17 T Y v x m U. f W W V\ N