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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-REFCiND LE PERMI-T CAL 209 953-7697 FOR INSPECTIO EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESSL-b CITY/ZIP L �V 1 Q :.I IA �O m CROSS STREET APN PAdRCEL SIZE O PHONE -1 7O I n 7 n OWNER NAME n � q v CKJ- OWNER ADDRESS O 'v CITY/STATE/ZIP S 1 L1 1 1� CONTRACTOR I)VwV ( C- PHONE CONTRACTOR ADDRESS -' CITY/STATE/ZIP LICENSEC-42 I l i C-36 OTHER A NUMBER 160C..:511 EXPIRATION DATE WATER TABLE DEPTH: n GEOGRAPHICAL INFORMATION: Coordlates X Y Ll PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: I RESIDENCE ❑ COMMERCIAL Ci OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPE/MFG 1, CAPACITY OO gal #OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS DISTANCE TO NEAREST: WELL n FOUNDATION n PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) _....-_..---_ -_....__..._ LEACH LINES LEACHING CHAMBERS #OF LINES 6 LENGTH OF LINES ft -7LOO DISTANCE TO NEAREST WELL n FOUNDATION n PROPERTY LINE ft FILTER BED WIDTH n LENGTH ft DEPTH 13 n DISTANCE TO NEAREST WELL It FOUNDATION n PROPERTY LINE It ❑ MOUNDED WIDTH n LENGTH n DEPTH ft DISTANCE TO NEAREST WELL n FOUNDATION n PROPERTY LINE VAII.- ft ❑ SUMPS WIDTH n LENGTH n DEPTH V ft DISTANCE TO NEAREST WELL n FOUNDATION n PROPERTY LINE [[�� ft E3 DISPOSAL PONDS WIDTH n LENGTH n DEPTH APP t n It DISTANCE TO NEAREST WELL It FOUNDATION n PROPERTY U n ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH AI 4*1 7y AQUI ft DISTANCE TO NEAREST WELL n FOUNDATION ft PROPERTY L T MEN NEn I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH Sr AN 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 WORKE COMPENS LION LAWS. 14 CALL 09 H R / REQUIRED FOR 1 )-953-Z627, SIGNED VLVTITLE DATE 10 M y _ PROPERTY UNE 168..66't 00 __ T i �y � nLY WiE�]pOµM M ------- --'-" p—'-'ser=erc.uNc i 4 i It see ro rtu orer N 11— z 4 ��/ ' O1 O Z $ z59r R E I tjO PRIG: � a �9 }�.,�.1 Com_, !- i is s �Y 001h.a §4i D g i �,y- � $ t3) 4 10 -� -S= C 1 8 $ A R I Z O 1$ - - - - ------ - D a scr-a+c.uric-- _—_--- j ses mxaou+r PROPERTY UNE 178.58'7 PARTMENT US ONLY Application Accepted By. Date 0 Area { Employee ID# Final Inspection ByfflEw Date PECIAL PERMIT-Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil C aracter: COMMENTS PE SC Received Chec Amount Date Permit/ Invoice# Permit ID# Code INFO BV Cash Remi!kd_f /� Service Request# '10-1" 0 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 5/5/17