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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)209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS �.l�6S"i NJ w si1LkA01_J CITY/ZIP L,#I r s CROSS STREET I �i� I I APN 9-3/Q D - I`� ----- PARCEL SIZE J OWNERNAME M ��(-1Af�� 32� J 66� PHONEU OWNER ADDRESS`_ /Sf hC- �c� � � CI Y TATE/ZIP CONTRACTORyy L'5-T W A a `✓� � L' PHONE '5-3") �� CONTRACTOR ADDRESS 3 J �X�`1 i CITY/STATE/ZIP �`� Z LJ 61 /� V LICENSE C-42 C-36 OTHER -!1 NUMBER vJ�1S r EXPIRATION DATE �v "_� �-AI! -. WATER TABLE DEPTH:Io/' v ft GEOGRAPHICAL INFORMATION: Coordinates X ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATIOg1 ` JU 19 TYPE OF WORK: X NEW INSTALLATION REPAIR/ADDITION ENGINEER Q WN IVE _ REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUdRAN NM AI,, '), (� INSTALLATION WILL SERVE: RESIDENCE COMMERCIAL OTHER TMENT NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS:_ NUMBER OF EMPLOYEES:_ f Of SEPTIC TANK TYPE/MFG • '�` CAPACITY gal #OF COMPARTMENTS 4- LJ ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS d DISTANCE TO NEAREST: WELL ,�5� ft FOUNDATION ZS' ft PROPERTY LINE ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) ❑ LEACH LINES x LEACHING CHAMBERS I N ft 4 t�,l #OF LINES LENGTH OF LINES S ' ft DISTANCE TO NEAREST WELL Il ft FOUNDATION L S''d ft PROPERTY LINE �� ft ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE It ❑ 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 1� SEEPAGE PITS NUMBER 3 WIDTH 422' ft DEPTH '2G ) ft DISTANCE TO NEAREST WELL r�.i+ ft FOUNDATION SV ft PROPERTY LINE S It 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 COMPEN5ATION LAWS. MINIMUM$X HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL (209)953-76977 SIGNED TITLE G i t N r DATE I ) 1 !J SAN OA QU N NT I � I iEPARTMENTAJSF O LY Application Accepted By low, j DateL Area I�L Employee ID# Final Inspection By Date 5y SPECIAL PERMIT-Approved by � Character of Soil to Depth of 3 F : Pit/Sump Soil Character: _ COMMENTS I A 43�/ OMMENTS/ PE SC Received heck# Amount Permit/ Code INFO B as Remitted Date Service Request# Invoice# Permit ID# 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 5/5/17