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jc14( 7 ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN�OAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 NON-REFUNDABLE �YPERMIT 7 CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS j�'/ ��" / �� { {^V Eit� CITY/ZIP y CROSS STREET ✓�� 1)✓L - y APN�I T (/ PARCEL SIZE v OWNER NAME C Y/-05 ! f 1",4/ O PHONE OWNER ADDRESS ! `/ �! `_ Y�/ —� CITY/STATE/ZIP CONTRACTOR I �(� �'�/�.LI 1) Y PHONE CONTRACTOR ADDRESS / � 7�(� Li/�- �J�J V CITY/STATE/ZIP 15��/��/�- ��/ LICENSE � l I C-42 L -36 OTHER NUMBER EXPIRATION DATE O— 3 WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION I ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT ICE DESTRUCTION L G INSTALLATION WILL SERVE: RESIDENCE COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPE/MFG / L,',) e) 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 LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE AfRourft ❑ MOUNDED WIDTH ft LENGTH ft DEPTH REr-C1\i�� ft DISTANCE To NEAREST WELL ft FOUNDATION ft PROPERTY LINE 1, ft M ❑ SUMPS WIDTH ft LENGTH ft DEPTH 9 6 www ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY �j ft OAQUIN COUNT, ft ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH u��'�n....__ DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY tWAL�p�uNMEN�� It ❑ 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. MI UR ADVAIWE N TICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 SIGNED . �LG- TITLE L'�r i-C-1-2 DATE 74 1 Lill /01 Ali EPARTMENT v S E a N L Y Application Accepted Date Area Employee ID# Final Inspection By Date 6 I SPECIAL PERMIT-Approved by Character of Soil to Depth of 3 t: Pit/Sump Soil Character: COMMENTS f° d 2 � I� /� nS �62r PE Sc Received Check#/ Amount Permit/ Code INFO sh emitted Date Service Request# Invoice# Permit ID# 42-01 / ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 5/5/17