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60 <br /> 6 so <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 <br /> NON-REFUNDABLE PERMIT A ( CALL 209 9953-7697 FOR INSPECTIONS EXP <br /> IRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS �`_� '2�� �� 1/�1�J/��J� �V�Q CITY/ZIP IL L J <br /> W �L y <br /> CROSS STREET $+1 LP>N�C APNO O PARCEL SIZE p1� <br /> ' -7 v <br /> OWNER NAME �✓ PHONE L-' �� 22`J <br /> ,p l- r � <br /> OWNER ADDRESS p•`� \ `�y r CITY/STATE/ZIP <br /> CONTRACTOR W ES I ✓� 3AL&(fAt%(, C. PHONE <br /> CONTRACTOR ADDRESS �� 1(a-- 1 CITY/STATE/ZIP Lz>1' CA c)S 2110 <br /> LICENSE I I C-42 � I C-36 OTHER A NUMBER EXPIRATION DATE `J^4 13 <br /> h1 <br /> WATER TABLE DEPTH:�V00 ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> oa <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: ' n NEW INSTALLATION R PAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE COMMERCIAL L THER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER 6 EMPLOYEES: �f <br /> SEPTIC TANK TYPE/MFG ��L' CAPACITY 2 06 ci gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL l ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES hC LEACHING CHAMBERS 1� t #OF LINES LENGTH OF LINES 60 ft <br /> DISTANCE TO NEAREST WELL�7y ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FO'LINDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION _ ft PROPERTY LINE 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 3 WIDTH S, ft DEPTH 2S , 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 /> WORKERS COMPENSATION LAWS. <br /> LAS <br /> MINIMUM HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 <br /> SIGNED TITLE �f tS"0 DATE f J "c) - <br /> A*! <br /> r <br /> 40 <br /> V <br /> -0 PARTMENT SEN Y ��� <br /> Application Accepted By Date 0 Area �-f�/ �� Employee ID# <br /> Final Inspection By_ Date Ll SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: it/Sump Soil Character: <br /> COMMENTS <br /> L(�tES S S� r •TS <br /> PMMENT <br /> PE SC Received heckif/ lo, Amount to Invoice# rtG Permit/ REQ�OWD <br /> Code INFO B Remitted D Service Request# OCT i 2018 <br /> SAN JOAQUIN COUNTY <br /> 42-01 ONSITE WASTEWATER f*MW4 RR IT <br /> 5/5/17 HEALTH DEPA N <br />