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ONSITE WASTEVVATER TREATMENT SYSTEM PERMIT 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 �TAM�ECtb 1�J _ CITY/ZIP CiEME 1-5 �i � CROSS STREET <<ee-"1 /5 A-D APN �I y- -No-1-/ PARCEL SIZE_ y OWNER NAME PHONE OWNER ADDRESS CITY/STATE/ZIPOW, _ y5/7,' U CONTRACTOR Ca^�STi� T SON J Tom. T^��. PHONE CONTRACTOR ADDRESS F,z" a O x �C __ _CITY/STATE/ZIP LICENSE L42C-42 I1-1C-36 OTHER NUMBER / > >�✓ EXPIRATION DATE d�L� WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y I-P 09 PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: NEW INSTALLATION EPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: RESIDENCE L COMMERCIAL OTHER NUMBER OF LIVING UNITS: "9 NUMBER OF BEDROOMS: Bc--m MBER OF EMPLOYEES: SEPTIC TANK TYPE/MFG F4 L e0uv L�_lTt= CAPACITY r�a gal #OF COMPARTMENTS z ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS DISTANCE TO NEAREST: WELL /9949-01 ft FOUNDATION ft PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) E3 LEACH LINES LEACHING CHAMBERS `n�7�n.td� #OF LINES `Z LENGTH OF LINES yo ' 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 It ❑ 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 It ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft SEEPAGE PITS NUMBER Z WIDTH 3 f ft DEPTH `2S+ ft DISTANCE TO NEAREST WELL f'S,I ft FOUNDATION ft PROPERTY LINE S f 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 COMPENS SON LAWS. MINIMUMf ;+-LOUR ADVANCE NOTICE REQUIRE"D FOR INSPECTIONS-PLEASE CALL (209)953-7697 SIGNED ♦' TITLEe-/1 ._ DATE 06EPARTMENT151SE tbNLfV Application Accepted R DateQ� Area Employee ID# Final Inspection By Date v ❑ SPE AL PERMIT-Approved by Character of Soil to Depth of 3 Ft: PittbunI Soil Character: COMMENTS CIIS PE Sc Received Check#/ Amount Permit! Code INFO B Cash Remitted Date Service Request# Invoice# Permit ID# CC *� D 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 5/5/17