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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 <br /> NON-REFUND R T y7�CCAALL�(`7(p�9')p9R1:i-7697FOR INSPECTIONS EXPIRES IYEA F D ISSUE <br /> Joe ADDRESS - �_ `` � _ __CITYMP _,�_ r <br /> �t.ct 32 — t/0— > <br /> CROSS STREET _ r�/��/�/ �/,/y/,� ��A.PN PARC/SEL QE p <br /> OWNER NAME ��=V I ' 153 <br /> I�(�� n '�'�'�I _L.� L�� O <br /> A' # P.ONNEE��Q r�A^, //� i <br /> OWNER ADDRESS 1" ^' CIISTATE/LP 1.��"tiM1�U !15032— <br /> A <br /> V�/3G— <br /> • / w � Q ie -6 -i / <br /> CONTRACTOR. y////�////����� � PMONE (������ ��j���) <br /> CONTRACT;O[R ADDRESS 4�_� "Sot, <br /> (n,. N CITY/STATE/ZIP_ `A A./�1A1._7` ._ 1 J" - <br /> LICENSE 11 C-42 I! C-36 OTHER I_ .. NUMBER 1(,J►[_5•1 EXPIRATION DATE _`'I ' _._. -- <br /> WATER TABLE DEPTH: V _ R GEOGRAPHICAL INFORMATION: Coordinates X Y. <br /> PERC TEST # BUILDING PERMIT# LAND USE APPLICATION <br /> TYPE OF WORK: NEW INSTALLATION W REPAat/ADDrnON ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: r ❑ RESIDENCE K COMMERCIAL L I OTHER_ —■r/ / -- <br /> NUMBER OF LIVING UNITS: C��'�(� NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ,�/ <br /> ElSEPTICTANK TYPE/MFG �✓�• j6 CAP ITY gal #OFCOMPARTMENTS9— <br /> ❑ GREASE TRAP TYPE/MFG _yS&jCCITY gal #OFCOMPARTMENTS <br /> DISTANCE To NEAREST: WELL it FOUNDATION it PROPERTY UNE ft <br /> ❑ LIFT STATION SIZE _ _TYPE OFPUMP__ ❑ PKGTXPLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> i <br /> I LEACH LINES LEACHI r�)?�rC�HHA-Ar�MBERS 15llNlT___ #OFLINESLENGTH OF LINES it <br /> DISTANCE Tj1k'INf9TL'1 WELL W)f1 FOUNDATION _it PROPERTY LINE it <br /> ❑ FILTER BED WIDTH --- ._____it LENGTH__ ___ `...___ it DEPTH It <br /> DISTANCE TO NEAREST WELL __ it FOUNDATION it PROPERTY LINE it <br /> ❑ MOUNDED WIDTH R LENGTH_ _.____. it DEPTH it <br /> DISTANCE TO NEAREST WELL It FOUNDATION. .ft PROPERTY LINE it <br /> Cl SUMPS WIDTH _K LENGTH_______..._____..._. K DEPTH i< <br /> DISTANCE TO NEAREST WELL _. it FOUNDATION_ it PROPERTY LINE it <br /> ❑ DISPOSAL PONDS WIDTH __ __it LENGTH___ ___ __ f< DEPTH it <br /> DISTANCE To NEARF9r WELL _ it FOUNDATION _ it PROPERTY LINE�17 it <br /> SEEPAGE PITS NUMBER z WIDTH___.._ _— ft DEPTH L it <br /> DISTANCE TO NEAREST WEL am"FOUNDATION �l.L T it 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 COMPENSATION LAWS. <br /> i <br /> HOW A A11V W&R OUIRFD FOR Tl ASE CALL 209 -76 <br /> SIGNED / JW _ _." TITLE _ _. DATE '. V <br /> �2K25' <br /> .. L L 15 C11�fz- -� C�lsnq•6 ��tl <br /> + MUSj C/0 (L <br /> 1 • <br /> i - Lg lap Law DP <br /> PAYME <br /> I <br /> - � A <br /> RECEIVE <br /> ,t <br /> p � r> t�p4=n MAR 1 6 201 <br /> -� SANJOAQUIN CO <br /> DIP A ENT1 ONLY HEALTH DEPARTME)4T <br /> Application Accepted By Date_ Area // % Employee ID# <br /> Final Inspection By ti Uata �_ �g I1 SP IAL PERMIT-Approvetlby <br /> Character of Soil to th of F _ _ _ Pit/Sump Sall Character: <br /> (;RMMENTS <br /> a <br /> i t <br /> PE SC Received Ch A ount Date Permit/ Invoice# Permit ID# <br /> Code INFO B ash Remitted Service R nest# <br /> 8- <br /> 42-01• ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 5/5/17 <br />