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SSI " ONSITE WASTEWATER TREA'rMENT SYSTEM PERMIT SAN JOAQUIWCOUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 NON-REFUNDABLE PERMIT c CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FRO DATE ISSUED JOB ADDRESS .11 5 1 !V Aian `-^-j L CITY21P C-Acn -3 v CROSS STREET ,J ��t�J� i\ j_`APN //// /�4�OD '�� PARCEL EZ}I� v p OWNER NAME �V�u dvi 4L. !\`��Si41bm6&-r, C�� 7/ PHONE 32 J�, ib OWNER ADDRESS SFV/ -'C { is �Q� C?5 CITY/STATE/ZIP CONTRACTOR " W'�SA�/ •"G� '' 1 ( �` PHONE J vA L 1 v CONTRACTOR ADDRESS ` V'l�`�` J 1 LJ � �J CITY/STATE/ZIP LICENSE I C-42 1 I C-36 OTHER NUMBER�3lIS] EXPIRATION DATE WATER TABLE DEPTH: / ft GEOGRAPHICAL INFO TION: COOrdln teS X Y ❑ PERC TEST # BUILDING PERMIT# LAND SE APPLICATION# TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT OUT-OF-SERVICE SEPTIC SY EM DESTRUCTION INSTALLATION WILL SERVE: Y`RESIDENCE 1, COMMERCIAL I_] OTHER NUMBER OF LIVING UNITS: f NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: SEPTIC TANK TYPE/MFG M _ CAPACITY gal #OF COMPARTMENTS 2 ^+ ❑ GREASE TRAP TYPE/MFG CAPACITY C gal #OF COMPARTMENTS DISTANCE TO NEAREST: WELL 13.) ft FOUNDAT N ft PROPERTY LINE 11-3 ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG T PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) r ❑ LEACH LINES J'` LEACHING CHAMBERS I P-1 Y 11I K""/ #OF LINES Z- LENGTH OF LINES !SS ft m DISTANCE TO NEAREST WELL 14,j ft OUNDATION S ft PROPERTY LINE ft - ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft OPERTY-_7: LINE ft C ❑ MOUNDED WIDTH ft NG ft DEPTH ft DISTANCE TO NEAREST WELL ft UNDATION ft R ERTY LINE ft �] ❑ SUMPS WIDTH ft LENGTH ft DRR ft DISTANCE TO NEAREST WELL ft OUNDATION ftPROPERTY LINE ft V ❑ DISPOSAL PONDS WIDTH ft LEND ftft DISTANCE TO NEAREST WELL ft FOUNDATIO1 �� PROPERTY LINE ft SEEPAGE PITS NUMBED Z WIDT / DEPTH ft DISTAN TO NEAREST ft FOUNDATION PROPERTY LINE 1J 1 ft I HEREBY CERTIFY THAT I HAV PREPARED THIS PPL IC TION AND THAT THE WORK WILL BE ONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, TATE LAWS, A D RULE AND REGULATIONS. I ALSO ERTIFY THAT MY REQUIRED LICENSE IS CURRENT AND ACTIVE WITH THE LIFOR A NTRACT S STA LICENICF_BOARD AID THAT I AM IN COMPLIANCE WITH ALL WORKERS COMPENSAIION LAWS. \j j MINIMUM HOUR ADVAN N E REQ IRED FCdMh SPECT ` -PLEASE CALL 209 953-7697 SIGNED E ! L--7 DATE 10 -16 '7 `'I t V) l JJ n ARTMENT U EO Y Application Accepted By Date C Area _SLI N"/ Employee ID#'00- � VF Final Inspection By Date ❑ SPECIAL PERMIT-Approved by Character of Soil to D ENth of 3 Ft: Pit/Sump Soil Character: COM TS . ( RAYMENT DAYMENx1rr_Enicn PE SC Received eck# Amount tInvoi Permit/ REC Inyt Code INFO B as Remitted/ o Service Request# Q 1 v IMT; Tj__ W 2018 , OCT 1 N JOAQUIN COU TY SAN L 42-01 ONSITE NENT M TEM PERMIT 5/5/17