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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT P — SAN JOAOU{N COUNTY ENVIRONMEN/TAL HEALTH PARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 NON-REFUNDABLE PERMIT (, 15'vl CALL (209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS ' \CL4A\ ' CITTY/ZIP �G'� �' G C ( J L �o CROSS STREET APN �� V U U PARCEL SIZE OWNER NAME��QV1v-TD%�� c f - _ _ _ PHONE A OWNER ADDRESS wl CITY/STATERIP 4>6 I ic-H CONTRACTOR PHONE CONTRACTOR ADDRESS CITY/STATE/ZIP LICENSE ❑ C-42 ❑ 'C-36 OTHER NUMBER _ EXPIRATION WATER TABLE DEPTH: f ft GEOGRAPHICAL INFORMATION: Coordinates X Y I.1 PERC TEST # BUILDING PERMIT # U LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION I I ENGINEER DESIGNED/ALTERNATIVE I REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM 11 DESTRUCTION INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL'? ❑ OTHER -NUMBER OF LIVING UNITS: I NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: qa/SEPTIC TANK TYPE/MFG �j L CAPACITY 1 100 gal # OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG ._ CAPACITY gal # OF COMPARTMENTS rr� DISTANCE TO NEAREST: WELL V U ft FOUNDATION ft PROPERTY LINE V ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) pf LEACH LINES LEACHING CHAMBERS � n jj r c► l (lr # OF LINES _2LENGTH OF LINES _] ft Date DISTANCE TO NEAREST WELL 1 U (J)t ft /(� FOUNDATION 10 je ft PROPERTY LINE /�V Y ft ❑ FILTER BED WIDTH ft LENGTH It DEPTH It DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft ❑ MOUNDED WIDTH _ ft LENGTH ft DEPTH It DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ SUMPS WIDTH _ ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE It ❑ DISPOSAL PONDS WIDTH _ _ It LENGTH It DEPTH ft DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY L,tNFj- ft C/ SEEPAGE PITS NUMBER 2 WIDTH 4 1t DEPTH �-7 It DISTANCE TO NEAREST WELL ft FOUNDATION U It 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. Application. ACceptpd By Final Inspection By Character of Soil to th of COMMENTS DATE ?--�/ ) DEPARTMENT USE ONLY (� Date • a 7- % _ Area _1 /�l_ Emplovee ID# Date Ll SPECIAL PERMIT - Approved by Pit/Sump Soil Character: PE Code SC INFO Chariall B Cash Amount Remitted Date Permit/ Service Request # Invoice # Permit ID# 10 'Ej-,�Q hi s 5— 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 5/5/17 r� Y