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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT P /' 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 EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS r 1 J06 5a D CITY/ZIP o MQ v / M CROSS STREET L ry1 e r Y APN %✓ ✓©�� /� PARCEL SIZE /' � v OWNER NAME' QU C �1, � LfC41 �V PHONE OWNER ADDRESS -d4l� , D1 C/ O CITY/STATE/QZIP/ c CONTRACTOR ply) -am i1r7 PHONE 7/(% r I t CONTRACTOR ADDRESS WS I 6-014 109 DrWe— CITY/STATE/ZIP �IL.Y —'140 zz W leL1 CA ` b LICENSE FI- C-42 I IVC-36 OTHER NUMBER W � EXPIRATION DATE WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y 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: ❑ RESIDENCE COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: y NUMBER OF 13DROOMS: NUMBER OF EMPLOYEES: SEPTIC TANK TYPE/MFG CAPACITY 'ZOv U� 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) xLEACHING CHAMBERS �LI #OF LINES 42 LENGTH OF LINES F,ee - ft / DISTANCE TO NEAREST WELLILTG It FOUNDATION ft PROPERTY LINE �+ ft ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE ft ❑ SUMPS WIDTH It LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH It DISTANCE ToNEAREST WELL ft FOUNDATION It PROPERTY LINE ft -1 SEEPAGE P TS NUMBER WIDTH 31 641 II-- ft DEPTH '95- ft d-A AM I..'' & DISTANCE TO NEAREST WELL j ft FOUNDATION 1 D T ft PROPERTY LINE JO F>= ft 1 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 0� SIGNED '�- TITLE DATE Z 01 W Z DG r i EP A R TM E N TJU SE N Y Appih:atiun Acca'-j1e n,ro Area ��"I _ Employee ID#� Final Inspection By Date ______ L; SPECIAL PERMIT-Approved by Character of Soil to Depth of-3 Ft: Pit/ u 'p Soil Character: _ �jy� COMMENTS /t L�1 L LO L �6A �.EF7ff l��/�49�—4 �I NI 1s da,M a o PE SC Received Check#/ Amount Date Permit/ Invoice# Permit ID# Code INFO By Cash Remitted Service Reguest# �pj� v O `�• 7` 2 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 5/5/17