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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 lJ f S �'� L CITY/ZIP CROSS STREETy 5adL C—A. , APN O 8(, PARCEL SIZEy� p M n� d OWNER NAME ,, cay l�1\Lwp, PHONE Phi OWNER ADDRES\SA'n CITY/STATE/ZIP CONTRACTOR V VC 7� '} � p �ll�/ PHONE 20� - 3/�3q .-73c11 4 c I I CONTRACTOR ADDRESS 7�we I ( SL CITY/STATE/ZIP w�I . l i I �J24c) LICENSE 1 1 C-42 I C-36 OTHER A NUMBERC► i 15-7 EXPIRATION DATE 2-o.2 � WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y ❑ PERC TEST # BUILDING PERMIT# 'I �' LAND USE APPLICATION# TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: I I RESIDENCE ❑ COMMERCIAL I_I OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: S- NUMBER OF EMPLOYEES: SEPTIC TANK TYPE/MFG ( CAPACITY ��`^� gal #OF COMPARTMENTS 7 ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS 1 ' _ DISTANCE TO NEAREST: WELL ft FOUNDATION J ft PROPERTY LINE Ili ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) Ll LEACH LINES 1J� LEACHING CHAMBERS %nfi I It aA1 Y S #OF LINES L� LENGTH OF LINES ► ft DISTANCE TO NEAREST WELL ft FOUNDATION \c>-' ft PROPERTY LINE 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 WIDTH '� ft DEPTH 2S n DISTANCE TO NEAREST WELL ft FOUNDATION to { ft PROPERTY LINE , } 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. MINIMUM 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 SIGNED A TITLE" DATE (6 Z _ DEPARTMENT USE ONLY /, Application Accepted By �� Date S J Area y q Employe__IDA Final Inspection By Date ❑ SPECIAL PERMIT-Apprq1& �7h1�►C�� Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS /)PS S E(, Or QU bl l i j er .1t f yodle,ore lel tom' rP( [ev)ed an ,dl��l db —C!2 ?020 ENV AQUIN CO PE SC Received hec Amount Permit/ P Code INFO B Cash Remitted Date Service Request# Invoice# ' �I4l��# y,911 1-7 -s g ..Z2-M 2 Z2'1-. 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 5/5/17