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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT P -/ SAN JOAQUIN C*)UNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 NON-REFUNDABLE PERMg CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS � I,i��/�J�Gj 1� r ---CITY/ZIP q �S�l� m // rr CROSS STREET �l0/04 �� APN L 19�740 7"0 PARCEL SIZE p OWNER NAME' y ori P � �eZ $ LU�"M ��1 __ PHONE �105 i162f' yF�SU OWNER ADDRESS q� i /I��W PI`- ' CITY/STATE/ZIP !W�NU�LAJ/� � �� CONTRACTOR PHONE CONTRACTOR ADDRESS -, ox ' _CITY/STATE/ZIP LICENSE 1>15,42 El' C-36 OTHER NUMBER 7 rS�rfd ySEXPIRATION DATE D WATER TABLE DEPTH: ( ft GEOGRAPHICAL INFORMATIO 00 ateS X__ Y Ll PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: NEW INSTALLATION R AIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM L1 DESTRUCTION INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: / NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: SEPTICTANK TYPE/MFG ��L CAPACITY gal #OFCOMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS DISTANCE TO NEAREST: WELL 1,0d It FOUNDATION ft PROPERTY LINE S ft L LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft i DISTANCE TO NEAREST WELL__ �- It FOUNDATION4123;R2 It PROPERTY LINE ft ❑ FILTER BED WIDTH It LENGTH ft DEPTH ft DISTANCE To NEAREST WELL ft FOUNDATION It PROPERTY LPAYMENT ft ❑ MOUNDED WIDTH ft LENGTH ft DEPTH RELIVED ft DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft ❑ SUMPS WIDTH ft LENGTH ft DEPTH SEP 7 7 2018 ft DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft ElDISPOSAL PONDS WIDTH _ It SAN JOAQUIN COUNTY LENGTH _ ft DEPTH ft ENVIRONMENTAt DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERNEANTH DEPARTMENT ft SEEPAGE PITS NUMBER�__ WIDTH 73' n ft DEPTH 12 ` ft DISTANCE TO NEAREST WELL 7S0/ _ It FOUNDATION /1�T It PROPERTYLINE ,j; 30 I 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 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL (209)953-7697 SIGNED _ _ -_ TITLE DATE 64 Ole- L 0 moo X PARTMENT VSE Y Application Accepted By Date_ Area Employee ID Final Inspection B �/l _ Date_ Z i SPECIAL PERMIT-Approved by p Y — ---- Character of Soil to Dep of 3 Ft. ___ iV-Sump Soil Character: COMMENTS �h b��G� /�fi �. L - '�6 w -e lhv-J PE SC Received heck#/ Amount Permit/ Code INFO B Cash Remitted Date Service Request# Invoice# Permit ID# 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 5/5/17