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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-NEFUNDABLEPERMIT CALL /209 953-7697_FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS %a 8 13O f��PA'� t✓T _ ____ CITY/ZIP LOC te 4;v/ CROSS STREET ' /GtJrGGf APN I v� PARCEL SIZE p OWNER NAME V �✓�IUI!-2� PHONE OWNER ADDRESS [ '/ / CITY/STATE/ZIP CONTRACTOR Ci✓IT'yl Vgll,' "/,n .S�G PHONE a-v 9" 3 r y -_5_0,-;1'7 CONTRACTOR ADDRESS �3�� OLsOH Ar• _ u_ p� _ __CITY/STATE/ZIP wp7SOp LICENSE CIC-42 11 IC-36 OTHER NUMBER 77�/ EXPIRATION DATE_ 7 ^J/ / WATER TABLE DEPTH: lJ I��+ ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT# _ LAND USE APPLICATION# TYPE OF WORK: I NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE I I REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: ( RESIDENCE I I COMMERCIAL? I1 OTHER NUMBER OF LIVING UNITS: _ NUMBER OFF BEDROOMS: J NUMBER OF EMPLOYEES: L3SEPTICTANK TYPE/MFG 4-w 6.19 lIONCr / 'ki� CAPACITY gal #OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS DISTANCE TO NEAREST: WELL ft FOUNDATION It PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP _ ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) ® LEACH LINES ❑ LEACHING CHAMBERS _ #OF LINES :L- LENGTH OF LINES `!O ft / DISTANCE TO NEAREST WELL /5- , �_.___ ft FOUNDATION �O ft PROPERTY LINE /00 ft ❑ FILTER BED WIDTH ft LENGTH _- __— ft DEPTH ft DISTANCE TO NEAREST WELL 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 It DEPTH ft DISTANCE TO NEAREST WELL _ It FOUNDATION ft PROPERTY LINE ft SEEPAGE PITS NUMBER 3 - WIDTH It DEPTH ;Ls ft DISTANCE TO NEAREST WELL_ 'Q0 ft FOUNDATION -D6 ft PROPERTY LINE �00 7 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. MINIMUM 24 HOUR ADVANCE. NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 IGNED _ TITLE * ✓ _ DATE •a A7-- � ED 2019 S N O IN OUNTY E VI 0 M NTAL TMENT PARTMF_NT IJ SC- N Y l J� Application Accepted By Date _ Area Employee ID#-�7✓ — Final Inspection By Date_ __ lCl SPECI L PERMIT Approved by Character of Soil tA Depth f 3 Ft:_ _ ' Pit/ urnp Soil Character: COMMENTS 1. f PE SC Received a Amount Permit/Code INFO B Cash emitted Date Service Request # Invoice# Permit ID# 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 5/5/17