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- FI ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> S.-N JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 <br /> NOf I-REFUNDABBLLE PERMIT 3 0 tt CALL 209 95r3'-87697 FOR INSPECTIONS EXPIRES`1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS T.L t6 M/J�;�� RA LI DIry CITYRIP L-4NJ <br /> i) rcN� v�y w 14 <br /> CROSS STREET v <br /> AP �( -/a ' / J PARCEL SIZE/ a 1-'~- <br /> O <br /> OWNER NAME �� o0 <br /> PHONE ly r <br /> 1-L <br /> OWNERADDRESS 1 Jazt CITY/STATE21P �L fin'1�. 'n C ZLI <br /> CONTRACTOR WG� 1f�ST r-7:1{r�HJL"a�1�VL PHONE- - 2o�- L'I�J <br /> CONTRACTOR ADDRESS CRY/STATE21P R-J+���"�� C-- 7 71"LICENSE Ot C-42 D 'C-36 OTHER A NUMBER Vc.�I�ss� EXPIRATION DATE_ Ly <br /> 1-0 <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION' Coordin eS X Y _ G <br /> n PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: X NEW INSTALLATION R PAIR/ADDITION L ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM L DESTRUCTION <br /> INSTALLATION WILL SERVE: �I( RESIDENCE COMMERCIAL A C OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: K NUMBER OF EMPLOYEES' 2` <br /> U' SEPTICTANK TYPEIMFG CAPACITY 1 S00 gal #OF COMPARTMENTS -2— <br /> J <br /> Z❑ GREASETRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCETO NEAREST: WELL It FOUNDATION It PROPERTY LINE ry <br /> '❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES LEACHING CHAMBERS I V4 i t%t(M3 f #OF LINES�`7 LENGTH OF LINES OR / ry <br /> DISTANCE TO NEAREST WELL i`�Q ft FOUNDATION Ift PROPERTY LINE 113* -4' If <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> 'DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE It <br /> ❑ MOUNDED WIDTH it LENGTH ft DEPTH It <br /> DISTANCE To NEAREST WELL It FOUNDATION ft PROPERTY LINE It <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH It <br /> DISTANCE To NEAREST WELL ft FOUNDATION ft PROPERTYUNE It <br /> ❑ DISPOSAL PONDS WIDTH It LENGTH ft DEPTH ft <br /> DISTANCE To NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH �iS�I It DEPTH ZS ry <br /> DISTANCE TO NEAREST WELL-LC,Q _it FOUNDATION 10'�^ It PROPERTY LINE <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 COMPENSATION LAWS. <br /> MINIMUM 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209),953-7697 <br /> SIGNED -7TITLE r `fJ t� DATE I'/ <br /> f � 1 <br /> !fi <br /> I 0 N <br /> H H .G <br /> ,( X���//yy D , r <br /> � LrVlJfLO ARTME:gUSEDNLY /////� <br /> Application Accepted B � i -��Date Area_� Employee ID# � <br /> Final Inspection By " Date LI SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth Of 3 Fe Pit/Sump Soil Character: <br /> COMMENTS�/1 ,rA) 14�.�1/l �1�7 w / 1� A / GZ� Ufa /fj/ <br /> PE Sc Received Check#/ Amount pate Permit/ Invoice# Permit ID# <br /> Code INFO �/By Cash Remi d _ Servic`e Re uue�stt# <br /> rel` �� � , I C I ✓tJ <br /> 42'01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 5/5/17 <br />