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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< CALL 209 953-7697 FOR INSPECTIONS � J C EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS f I t�J Se-1 '/tke r RN CITY/ZIP ' J I( f� LA CROSS STREET � t/ 1 � APNi �7L� T PARCEL SIZE y OWNER NAME Moo , roe:(m'-L- r'(ii�y��p� PHONE OWNER ADDRESS (Oo4l D�+w V V"- Cr CITY/STATE/ZIP CONTRACTOR ' 11�-�— h��-(�'7 J/� /1/i Y-ti PHONE CONTRACTOR ADDRESS � l�' � CITY/STATE/ZIP 141 e4 t'"' LICENSE I C-42 1-1 C-36 OTHER NUMBER c' d5�� EXPIRATION DATE [ A WATER TABLE DEPTH: O 71 ft GEOGRAPHICAL INFORMATION: Coordinates X Y PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: NEW INSTALLATION R PAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: IL I ESIDENCE El COMMERCIAL` ❑ OTHER , NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: L NUMBER OF EMPLOYEES: SEPTIC TANK TYPE/MFG �'}"L CAPACITY 1 Is!n gal #OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS i DISTANCE TO NEAREST: WELL I rx0 ft FOUNDATION I It PROPERTY LINE 7 J� ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) .—.................._........ .___ ......._..............--- ..._......--.... ---- ._ __.. �_��....._.—�—_....._ ._..............-_.._--- -- —__ .__-............ ......._.._. i LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES r� It DISTANCE TO NEAREST WELL 10D ft FOUNDATION I 0 ft PROPERTY LINE Som ft ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE C ft Ems(L ❑ MOUNDED WIDTH ft LENGTH ft DEPTH P Tft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE cs- nr ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE 3 9fitRft ❑ DISPOSAL PONDS WIDTH It LENGTH ft DEPTH SAN I0AQtjjf fifty DISTANCE TO NEAREST WELL ! ft FOUNDATION _ ft PROPERT�LIN EEA piprlG.`N TT �EEPAGE PITS NUMBER 3 WIDTH Ila Ii ft DEPTH 4;A-S- LTH EPARTMENfIt DISTANCE TO NEAREST WELLA�i ft FOUNDATION If O ft PROPERTY LINE SZ5"t' 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____Cf0n7i'('cc;7y DATE f 1r /3 1 d�) 1 4.0 io D PARTMENT SE O L Y �J Application Accepted tD,te ' Ar a �'L Employee ID# A~ Final Inspection By Date �9�2,dy7 SPECIAL PERMIT-Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: - COMMENTS MAP— —Alk,�'T- , 7t,11f t�✓ _ lL2 I/ L � .gayto it�l�7Gi ttlr/j'J 1 L- Cwer- CiF PE SC Received (6%0" Amount Date Permit/ Invoice# Permit ID# Code INFO B ash Remitted Service Request# 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 5/5/17