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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 /> 1 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> Joe ADDRESS O ` \ crrr1r/L 1c7f���_� <br /> CROSS STREET ` APN `�_ 1 PARCEL SIZE <br /> OWNER NAME I F+S 'p1L- Ar1,1 G -I- t p1 _ __. _ PHONE (/1 <br /> OWNERADDRESS 2 1��ISG 1�SJ CITY/STATE/ZIIPP1('']C�,�i.-/��Yy1-�V�•//1�'�`c�h <br /> CONTRACTOR -=SSIF - O j7v PHONE —O 1'ILZ 0C. 2 .7 <br /> CONTRACTOR ADDRESS CITY/STATEIZIP <br /> LICENSE C-42 C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: It GEOGRAPHICAL INFORMATION: Coordinates X Y_ <br /> 1 PERC TEST If _ __ BUILDING PERMIT# LAND USE APPLICATION#_ <br /> TYPE OF WORK: NEW INSTALLATION R AIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT _ OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTANLATION WILL <br /> NG UNITS: NUMBER OF BE COMMERCIAL OTHER. _ <br /> RESIDENCE <br /> UMBER <br /> BEDROOMS:_ _ NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG _ _ CAPACITY gal #OF COMPARTMENTS y <br /> ,g GREASE TRAP TYPE/MFG�"h-'L' CAPACITYi x: gal #OF COMPARTMENTTS��`+ <br /> DISTANCE TO NEAREST: WELL ,L'�-? it FOUNDATION ft PROPERTY LINE I it <br /> ElLIFT STATION SIZE TYPE OF PUMP U PKGTXPLANT O SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES It <br /> DISTANCE TO NEAREST WELLit FOUNDATION __ft PROPERTY LINE _ It <br /> ❑ FILTER BED WIDTH H LENGTH _ ft DEPTH _ _ It <br /> DISTANCE TO NEAREST WELL It FOUNDATION it PROPERTY LINE It <br /> ❑ MOUNDED WIDTH It LENGTH ft DEPTH __ It <br /> DISTANCE TO NEAREST WELLIt FOUNDATION it PROPERTY UNE___ ft <br /> ❑ SUMPS WIDTH It LENGTH ft DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE It <br /> ❑ DISPOSAL PONDS WIDTH__ ft LENGTH _ H DEPTH It <br /> DISTANCE TO NEAREST WELLIt FOUNDATION ft PROPERTY LINE_ It <br /> ❑ SEEPAGE PITS NUMBER - WIDTH _ ft DEPTH it <br /> DISTANCE TO NEAREST WELL H FOUNDATION h 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 COMPENWION LAWS. <br /> MINIMUM 4, OUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-769 <br /> SIGNED _. _. -- TITLE OWMQ+ DATE O� <br /> N <br /> Q //y <br /> O <br /> 71M <br /> EPARTMENT SE101I <br /> Application Accepted By Data Area Employee ID# /`� <br /> Final Inspection By Date SPECIAL PERMIT-Approved by <br /> Character of Soil to Dep of 3 F. Pit Sump Soil Character: <br /> COMMENTS -rO WaV K- Dfbl <br /> InA W <br /> - <br /> PE SC Received Amount Data Permit/ Invoice k Permit I <br /> Code INFO B ash emitted Service Request# <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 5/5/17 <br />