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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTHDEPARTMENT 1868E.HAZELTON AVENUE-STOCKTON CA 95205-(209)4683420 <br /> NON-REFUNDABLE PERMIT CALL 209 3-7697FoRINSPEcTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS C"m' <br /> CROSSSTREET APN ra�oS-D70 -37 PARCELSUE <br /> OWNER NAME OSe. v(2— PHONE_za!1 - 5����03y <br /> OWNER ADDRESS ^ &t-) Ay-e. CR/STATEMP �7O' &= <br /> CONTRACTOR VId Aa PHONE <br /> 9J JLG <br /> U <br /> CONTRACTOR ADDRESS COIYSTATEMP <br /> LICENSE F] C42 ❑'CSB OTHER NUMBER EXPIRATIONDATE <br /> C�]� I f <br /> WATERTASLEDEPIH:�/� �/O K GEOGRAPHICALINFORMATION: Coordinates X V <br /> ❑ PERCTEST aT_ BUILDING PERMIT# — LAND USE AP PLICATION# <br /> TYPE OF WORK: NEW INSTALLATION REPAIR/ADORR)N ENGINEERDEMGNEDIALTERIMTRIE <br /> J REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTIIDCTMJN <br /> INSTALLATION WILLSERVE: ❑ RESIENCE I COMMERCIAL OTHER <br /> NUMBEROF LYING UNITS: NUMBER OF BEDROOMS: NUM9EROF EMPLOYEES: <br /> _SEPTIC TANK TVPF/MFG CAPACITY gal NOFCOMPARTMENTS k� <br /> ❑ GREASETRAP TYPE/MFG CAPACITY gal kOFCOMPARTMENTS <br /> DISTANCE TO NEAREST: WELL `2lJ R FOUNDATION R PROPERTY LINE fl <br /> ❑ LIFT STATION SIZE TYPEOFPUMP O PKGTXPLANT O SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES ) LEACHING CHAMBERS— kOF LINES LENGTHOFLINES R <br /> DISTANCE TO NEAREST WELL�G/� f.�If FOUNDATION—ft PROPERTY LINE It <br /> ❑ FILTER BED MOTH N LENGTH � K DEPTH R <br /> DISTANCE TO NEAREST WELL K FOUNDATION R PROPERTY LINE R <br /> ❑ MOUNDED YAOTH R LENGTH K DEPTH R <br /> DISTANCE TO NEAREST WELL It FOUNDATION R PROPERTYUNE R <br /> ❑ SUMPS MOTH K LENGTH R DEPTH R <br /> DISTANCE TG NEAREST WELL K FOUNDATION R PROPERTYUNE R <br /> ❑ DISPOSAL PONDS WIDTH K LENGTH If DEPTH R <br /> DISTANCE TO NEAREST WELLK FOUNDATION K PROPERTYLINE R <br /> ❑ SEEPAGE PITS NuMeER WITH R DEPTH ft <br /> DISTANCETONEAREST WELLR FOUNDATION K PROPERTY LINE It <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN <br /> JOAQUIN COUNTY ORDINANCES. STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br /> CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br /> WORKERS COM PEN ON LAWS. <br /> MINI HOUR ADVA TICE REOUIRED FOR INSP CTIA N.SS-PLEASE CALL 209 963-7697 <br /> SIGN E U TITLE F�.c��{�y DATE <br /> NT <br /> O <br /> c 0114 <br /> I I I all I all <br /> 1pEpARr <br /> NTy <br /> f <br /> Application Accepted By Data Area Employe°IDp� <br /> Final Inspection By. '�'L Data 50 ❑ SPEIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: S � PIh$ump Soli Chereeter: <br /> COMMENTS <br /> PE I Be I Received I Cheek#/ Amount Date Permit/ Invoice# PermNID# <br /> Code INFO Me; Cash emitted ServiceRe Ueat k <br /> {,JL +++8t 00--7-n 3 <br /> WW1 W-�f/ /�'7�I ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />