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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 XPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS :32— q 1 CITY/ZIP C C CROSS STREET APN 7 L` Q l/V PARCEL SIZE 0 d OWNER NAME t^ PHONE ! D J' CO�T j OWNER ADDRESS 3741-21 7 � CITY/STATE/ZIP 3 CONTRACTOR PHONE J CONTRACTOR ADDRESS CITY/STATE/ZIP LICENSE I C-42 I C-36 OTHER NUMBER EXPIRATION DATE WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y l PERC TEST # BUILDING PERMIT#JV I 4LAND USE APPLICATION# TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION I ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM 1 ' DESTRUCTION INSTALLATION WILL SERVE: !` RESIDENCE COMMERCIAL �j J 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: WELLI(�C tL ft FOUNDATION ft PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) ❑ LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft DISTANCE TO NEAREST WELL ft FO NDATION ft PROPERTY�IfVE ft m FILTER BED WIDTH 2-V ft LENGTH ft DEPTH��(( � ¢2 ft DISTANCE TO NEAREST WELL 06 t 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 WIDTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE 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. MINIMU,M 448 H R ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 SIGNE �' TITLES j Ir DATE2-- '-E --2-C-)I / S14N JOADUIN O N „D PARTMENTAI-SilONLY E%ppiication Accepted By Date Area Employee ID# Final Inspection By /Y Date S $PEC AL PERMIT Approved by Character of Soil to Depth of 3 Ft: Pi Sump Soil Ch racter: COMMENTS PE SC Received Check#/' Amount Permit/Code INFO B Cash Remitted Date Service Request# Invoice# Permit ID# 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 5/5/17