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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 209 953-7697FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS D ` CITY/ZIP a sc--F16 i � Q � CROSS STREET ` � APN 4� � �/ 1 PARCEL SIZE tv d L OWNER NAME Z N A 7J PHONE (``__o OWNER ADDRESS c / CITY/STATE/ZIP CONTRACTOR i ��"'J Q 16-anj( �-r PHONE "1'576- CONTRACTOR ADDRESS ® tJo lF S " }� ,j CITY/STATE21P e-q�C LICENSE 1i iC-42 F1 IC-36 OTHER NUMBER&fJ-�DV575 • EXPIRATIONDATE WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION I ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT i OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION Old INSTALLATION WILL SERVE: VOIRESIDENCE 1_I COMMERCIAL 0016THER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: SEPTIC TANK TYPE/MFGL CAPACITY n�11 gal #OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS � I L e DISTANCE TO NEAREST: WELL ft FOUNDATION / tS ft PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) EACH LINES I I LEACHING CHAMBERS #OF LINES—2LENGTH OF LINES ft DISTANCE To NEAREST WELL 1`®' �1 r ft FOUNDATION OW ft PROPERTY LINE .0ft FILTER BED WIDTH _�.'1 ft LENGTH iI+�!r ft DEPTH q�I/ ft DISTANCE TO NEAREST WELL /1ti_ ?Y ft FOUNDATION 77 ? ft PROPERTY LINE ( d a 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 WIDTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft 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 48 H URADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 SIGNED TITLE » �'' �I r DATE 1 4,% 1� Ogg FNV4 -e 5 Ty i M j)Nry T Nr v, D PAR NT SEO LY A AA Application Accepted By Date4/-.—) -^ Area Employee ID# Final Inspection By Date ❑ SPE IAL PERMIT-Approved by Character of Soil to Depth of 3 Ft: Pit1Sump Soil Character: COMM TS a ? , PE Sc Received ec Amount Date Permit/ Invoice# Permit ID# Code INFO ash mitted Service Request t# Its 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 5/5/17