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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-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS U. E E CITY/ZIP !e`L/-N r-\R bCROSlAPN ©� I D ZE /4 S STREET OWNERNAME Sya�� C�C'ISC{'�P�-f 'J PHONE__ �� J � OWNERADDREES�S�y�,� �"'�SR� f�- CITY/STATE21P CONTRACTOR�M`'S-"�S/ V�u^��•� - ),-,I C! PHONE CONTRACTOR ADDRESS J� �w_ellI{G C.� CITY/STATEIZIP L V� ��''10-1 LICENSE ❑11C-42 ❑I1C-36 OTHER A NUMBER 1 -7EXPIRATION DATE WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y r 11PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# V' TYPE OF WORK: NEW INSTALLATION ❑ REPAIR/ADDITION I-' ENGINEER DESIGNED/ALTERNATIVE Y l REPLACEMENT ❑ OUT-OF-SERVICE SEPTIC SYSTEM a DESTRUCTION INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: 1 NUMBER OF BEDROOMS: 7 NUMBER OF EMPLOYEES: r� SEPTIC TANK TYPE/MFG '` ` CAPACITY 00 gal #OF COMPARTMENTS_ ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS G DISTANCE TO NEAREST: WELL 13d ft FOUNDATION S' ft PROPERTY LINE .J i ft V ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) ❑ LEACH LINES LEACHING CHAMBERS I IV 41 1 t M`e1 #OF LINES_ LENGTH OF LINESI ft DISTANCE TO NEAREST WELL 101 it FOUNDATION 13 ft PROPERTYLINE S ` ft (� ❑ FILTER BED WIDTH it LENGTH ft DEPTH ft �} DISTANCE TO NEAREST WELL it FOUNDATION ft PROPERTY LINE ft ❑ MOUNDED WIDTH it LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ SUMPS WIDTH It LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE it ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH it DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE it �11. SEEPAGE PITS NUMBER WIDTH 36 I ft DEPTH 7-S ' ft DISTANCE TO NEAREST WELL i +T ft FOUNDATION 13' ft PROPERTY LINE S It 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 1 AM IN COMPLIANCE WITH ALL WORKERS COMPENSATION LAWS. MINIMUM 48 HOUB.AD VANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 SIGNED TITLE ?r f,S o i-'a DATE C� yMFNT 4 ?020 A TN O(jlT), / J DEPARTMENT U E ONLY q �R MENT Application Accepted By �_ L 1, Date L/ 2070 _ Area _ Employee ID# sk Final Inspection By�'1��1k+7 �i Date_ _�E/` -VEL? ❑ SPECIAL PERMIT-Approved by Character of Soil to Depth of 3 Ft: PiUSump Soil Character: COMMENTS P!e,) SFR. 1,Pr PE SC Received Checl<#/ Amount PermiU Code INFO Bi Cash Remitted Date Service Request#/ Invoice# Permit ID# S q.114 ,20 S O S o 42-01 x� D� ONSITE WASTEWATER TRTMNT SYSTEM PERMIT I 4/14/18 `��'��""il L SG