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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 <br /> �NON-REFUND P RMITCALL 209 953 FOR INSPECTION EXPIRES 1 Y ARF ATE ISSUED <br /> JOB ADDRESS CITYRIP y <br /> CROSS STREET APN_01—I—WO_ �� PARCEL SIZE '6! p <br /> if) 0r?-l U7 <br /> OWNER NAME ; PHONE <br /> m � ��v <br /> g <br /> 5�36OWNER ADDRESS CITY/STATE/ZIP +n/ <br /> L <br /> CONTRACTORD,_ A - Av, � PHONE V� 6 77 <br /> CONTRACTOR ADDRESS �oJ j - —CITY/STATE21P_ <br /> ie:A <br /> LICENSE PLIC-42 ❑,-C-36 OTHER NUMBER ! EXPIRATION DATE 119 <br /> V - PLL <br /> 3+ <br /> WATER TABLE DEPTH:In /,n y ft GEOGRAPHICAL INFORMATION: Coordinates X Y IRR <br /> PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION X R PAIR/ADDITION ENGINEER DESIGNED/ L E IV <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION SAN <br /> INSTALLATION WILL SERVERESIDENCE IJ COMMERCIAL Q ❑ OTHER <br /> NUMBER OF LIVING UNITS: l NUMBER <br /> //OFOF BEDROOMS: J NUMBER OF EMPLOYEES.­" <br /> SEPTIC TANK TYPE/MFG Ov^ CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> 14 LEACH LINES Y. LEACHING CHAMBERS 4 #OF LINES�— LENGTH OF LINES 55 ft <br /> DISTANCE TO NEAREST WELL 100+ ft FOUNDATION I V� ft PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION V <br /> ft PROPERTY LINE ft <br /> l4 SUMPS WIDTH 4- ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL I l I ft FOUNDATION ft PROPERTY LINE (on ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN <br /> JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br /> CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br /> WORKE S COMPENrS��ATTION LAWS. <br /> lb <br /> M X7l U T CE REQUIRED FOR INGRECTION6-PLEASE CALL 209 W3-7627 <br /> SIGNED TITLE:. DATE <br /> LOW <br /> II:71 if l.i -rI <br /> + . ._ <br /> -U. <br /> f'1�..�,f�-• I .j, ',! I ,, �' I � r .�.,.1 I I .� I i.. 1. _I LI i I J <br /> ..I rT" <br /> .71 <br /> ! (. <br /> a <br /> v <br /> - <br /> .. <br /> TA <br /> -7- <br /> II _ ht• ,� 0�)C I + tri 0>✓SDS+ . .. } '.I I I_.I i -I + I . <br /> �..1.1f �- 1 ;7YsSYBM <br /> i I-- •i <br /> .1 <br /> I4 t� <br /> aaa�ap4o{V P oJwd fi. <br /> o <br /> 74 <br /> { ''" H eq AkuXs'Jta i* <br /> i.a .A 1�•i-- i _'t,�tll}!.y�C I��t.tl C, <br /> I ' + <br /> Application Accepted By Dat Cj Area Employee ID# <br /> Final Inspection By Date 0, ❑ SPEC AL PERMIT-Approved by IN <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS <br /> 44 jli:yle 5, <br /> PE SC Received ChecAmount DaPermit/ <br /> Code INFO B ash Remitted d+ Date vice Request# Invoice# Permit ID# <br /> 1 , dl <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 5/5/17 <br />