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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-REFUNDABLE PERMIT,,/ CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS S7 3 y g -<A Cdn// FLe CITY/ <br /> ZIP <br /> i4e& �f S <br /> CROSS STREET Pet,/ Jr,s � APN C) PARCEL SIZE <br /> z/ <br /> i 6 3 <br /> OWNERNAME DrYw Sb)b e- PHONE Sao- V60 y� <br /> m <br /> OWNER ADDRESS 47-5 l W , S J* _ CITY/STATE/Z-IIP� _ V( <br /> CONTRACTOR �rT l7/�!3 L ��f -5A0/7G_ PHONE <br /> CONTRACTOR ADDRESS 31r� 0% U —CITY/STATE/ZIP <br /> LICENSE 12�e_t-42 Ll C-36 OTHER NUMBER ys EXPIRATION DATE <br /> WATER TABLE DEPTH: It GEOGRAPHICAL INFORMATION: Coordinates X---- Y <br /> LL PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNAT E <br /> REPLACEMENT 3 13c,.Q— OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION C- <br /> INSTALL ATION WILL SERVE: RESIDENCE 0 COMMERCIAL ❑ OTHER ' <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS:_ NUMBER OF EMPLOYEES: <br /> ®— SEPTIC TANK TYPE/MFG top-1- __ CAPACITY Jd _ gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL166 , _ ft FOUNDATION ft PROPERTY LINE JLO ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> t9— LEACH LINES 4—LEACHING CHAMBERS AMW 7S #OF LINES LENGTH OF LINES �� ft <br /> DISTANCE To NEAREST WELL " �0- ft FOUNDATION 55 It PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH _ ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE To NEAREST WELL ft FOUNDATION ft PROPERTY LIN PA YA. . ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH �P <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH uk'�+ C f ., ft <br /> DISTANCE TO NEAREST WELL _ ft FOUNDATION ft PROPERTY I&& - uIt <br /> L3 SEEPAGE PITS NUMBER- WIDTH ft DEPTH FHI/iz QV//V ft <br /> DISTANCE To NEAREST WELL ft FOUNDATION ft PROPERTY LINE TND .EN7'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 /> MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL (209)953-7697 <br /> SIGNED X-�-��— TITLE DATE )ZY>O1Jk <br /> • t <br /> IF I <br /> -in <br /> O <br /> 1D <br /> 1 <br /> t EPARTMENT LkSE <br /> Application Accepted Date Area Employee ID# <br /> Final Inspection By Date / ❑ SPECT L PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: PiUS mp Soil Character: <br /> COMMENTS tztil S <br /> L-1AL—CS <br /> PE SC Received he Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO ash Remi d Service Request# <br /> -2 <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 5/5/17 <br />