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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 r 1 CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS � � L�ISI �D TCL E� CITY/ZIPI5uy�:w y5_3 7C; APN -2OS— '4C— 1 CROSS STREET D�+�i S �%� PARCEL SIZE v L v OWNER NAME �YLec. 227 Y-z Ze T PHONE !j,�t3- OWNER ADDRESS CITY/STATE/ZIP CONTRACTOR �GilhU7��/L__ PHONE 3b% S74 Z/7 L CONTRACTOR ADDRESS ;T3lL 0AUK0 I,'>A2' / CCITY/STATE/ZIP' ' LICENSE I -42 71 C-36 OTHER NUMBER 7� � yYEXPIRATION DATE O�:131/C1 WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y Fl PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION I ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: RESIDENCE j COMMERCIAL I I OTHER NUMBER OF LIVING UNITS: I NUMBER OF BEDROOMS: ,I NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPE/MFG ��Sfij CAPACITY gal #OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) VLEACH LINES I LEACHING CHAMBERS #OF LINES LENGTH OF LINES �U ft DISTANCE TO NEAREST WELL )56 + ft FOUNDATION 15 ft PROPERTY LINE 73& ft ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE 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 JL WIDTH, -3: ft DEPTH :�•� ft DISTANCE TO NEAREST WELL I YQ - ft FOUNDATION 1/0 ft PROPERTY LINE 30• 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 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIO S-PLEASE CALL 209 953-7697 SIGNED '� TITLE Ae:;*f0 ;e-" i't' DATE Z x (lie I T IJ 19 s J N) RON6 LNTy �P R NT P DEPARTMENT USE ONLY `r Application Accepted.By Date / /Y Z 2-019 Area Employee ID# �S-Q+ A Final Inspection By I = Date -V1// ❑ SPECIAL PERMIT-Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS PE SC Received Amount Date Permit/ Invoice# Permit ID# Code INFO By Cash Remitted Service Request# z3 6l 300 151 S R d 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 5/5/17