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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 1'T `V CITY/ZIP y CROSS STREET Y V1 nal f I APN ©3 5 �O�I PARCEL SIZE d OWNER NAME �'C-(�-1 ��,� PHONE OWNER ADDRESS `� �/ f ��p CITY/STATER/IJP 11 J 2�V�/moi CONTRACTOR�1QS� �AMS� �C�l{ri PHONE /�JC� '1371 —73L CONTRACTOR ADDRESS 33 miume I 1 �l CITY/STATE/ZIP `— ��/C/4 LICENSE I I i C-42 L LIC-36 OTHER A NUMBER 35115"1 1 EXPIRATION DATE ?-0Z 3 WATER TABLE DEPTH: It GEOGRAPHICAL INFORMATION: Coordinates X Y PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: I NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIG ED/ LTERNATIVE REPLACEMENT r, EF, OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION t4lll< INSTALLATION WILL SERVE: RESIDENCE COMMERCIAL OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: `S NUMBER OF EMPLOYEES: SEPTIC TANK TYPE/MFG CAPACITY ' U.J gal #OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS DISTANCE TO NEAREST: WELL ft FOUNDATION ��+ ft PROPERTY LINE �L. ft ❑ LIFT STATION SIZE TYPE OF PUMP , LlPKG TX PLANT Ll SAND OIL SEPARATOR(ENCLOSED SYSTEM) LI LEACH LINES LEACHING CHAMBERS 'ky)6 I W(L(�� #OF LINES I LENGTH OF LINES S S ft DISTANCE TO NEAREST WELL I U F ft FOUNDATION `L ft PROPERTY LINE f L ft ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ 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 It FOUNDATION ft PROPERTY LINE ft ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft SEEPAGE PITS NUMBER WIDTH1 calft DEPTH LS ft DISTANCE TO NEAREST WELL I U_i V I ft FOUNDATIONIl l ft PROPERTY LINE O+ 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 COMPENSATION LAWS. MINW-U—A48 HOUR ADVANCE NOTICE REQUIRED FOR 1AISPECTIONS-PLEA E CALL 209 3-7697 SIGNED TITLE KO- V DATE I\ i 11:• X � N N PA J DEPARTMENTA19E ONLY �/? Application Accepted By `�` Date—!A JOE' Area Employee ID#_,�A Final Inspection By Date R/,, '� I I SPECIAL PERMIT-Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS t1n CvNtr cfar 5h:}ed re 0SEC.1Ifs U �� h 'S► �,I c �'� It. 6*I 9X) ti'V7 of qhd A) M Mat ,11`rH;r sef ucksF�'Won reccrCIS and po!5 ins 1+'len & bf—Me S,Qfi PE SC Received Check#/ Amount Permit/Code INFO B Cash Remitte(d� DUate'It Service Request# Invoice# Permit ID# ZV 9� LZ`t well Ui`I ?fafet4y C OPS nar IMeef" CU!leol re jo4le 4eN 2- 01 r✓x15��S �Jr a Y>�eXr%��5 fXs m -1/ly/xJ� Reco IY e;P de:5+tul I kkl bf ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 5 spy vier�