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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 209 953-7697 FOR INSPECTIONS e EExP,IRES 1 YEAR FROMDATE ISSUED JOB ADDRESS ^ CITY/ZIP I�C� ! 4 ' L cSCP CROSS STREET KJ APN�� 2730 - 0 PARCEL SIZE 4 G C OWNER NAME PHONE OWNER ADDRESS CITY/STATE/ZIP CONTRACTORa�IG.GS �tt d' PHONE �[ t5(y a��✓S' ��II CONTRACTOR ADDRESS &S 1—� r O CITY/STATE/ZIP — CA�tz.h :�'�' 4I..5'-Yv LICENSE Di IC 42 C-36 OTHER C NUMBER J EXPIRATION DATE �,fV WATER TABLE DEPTH:7/�` �L ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: I NEW INSTALLATION REPAIR/ADDITION I ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT I I OUT-OF-SERVICE SEPTIC SYSTEM I DESTRUCTION INSTALLATION WILL SERVE: RESIDENCE D COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPE/MFG 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) ❑ LEACH LINES I I LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE FILTER BED WIDTH i ft LENGTH �� 1 ft DEPTHI�rt e fl" DISTANCE TO NEAREST WELL 1 %-01 ft FOUNDATION .7 t ft PROPERTY LINE , ft "1 ❑ 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 h � 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 -44N N ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY MNE ft AM I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN AC� ®� SSM JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY R� cl�. IS CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE ALL WORKERS COMPENSATION LAWS. MINIMUM 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 SIGNED TITLE GC`1n' Cr-e'F ^ DATE 1 Cy Y t or 'D PARTMENTAJSEVNLY Application Accepted By DateI Area Employee 047 �w Final Inspection By W Date III SPEC L PERMIT-Approved by Character of Soil to Death of 3 Ft. it/Sump Soil Character: COMMENTS ✓ ll , Herhe �, I `1 1 q I X02 PE SC Received Che Amount Permit/ ode INFO By, hash Remitted Date Service Re est# Invoice# Permit ID# d Rv 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 5/5/17