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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 20` s E t1�I,f J� S�f �N p CITYIZIP �o I CROSS STREET ( APN 058' 2 01 P PARCEL SIZE l p/ _ OWNER NAME VC.i�?�� /�1z5 ) PHONE O_I) 30� 8677 OWNER ADDRESS\ gois Afyo/ys for RC .(� CITY/STATE/ZIP hL/0�rj 9saya CONTRACTOR V �1i+ 21.L/ULAS�(k v�� C I��(�'`�' PHONE TV'1 ~339 v 339 �(, CONTRACTOR ADDRESS ✓ AecxV CrII Ef (y1�C c CITYISTATE21P Lodi Fl (A C15724D LICENSE EI11C-42 ❑I IC -36, OTHER A NUMBER U v J� EXPIRATION DATE WATER TABLE DEPTH: fl GEOGRAPHICAL INFORMATION: ❑ PERC TEST # F BUILDING PERMIT # TYPE OF WORK: U NEW INSTALLATION REPLACEMENT kiilit > ) ��/ Coordinates X LAND USE APPLICATION OUT -OF -SERVICE SEPTIC SYSTEM INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: n Y UI I ENGINEER DESIGNED / LTERNATIVE DESTRUCTION �O NUMBER OF EMPLOYEES: SEPTIC TANK TYPE/MFG CAPACITY `-' gat #OFCOMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gel # OF COMPARTMENTS DISTANCE TO NEAREST: WELL 100 ft FOUNDATION S } ft PROPERTY LINE ❑ LIFT STATION SIZE 'TYPE OF PUMP ❑ PKG TX PLANT Z❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) ❑ LEACH LINES LEACHING CHAMBERS # OF LINES J LENGTH OF LINES U ft DISTANCE TO NEAREST WELL. ft FOUNDATION ft PROPERTY LINE ft ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft ❑ MOUNDED WIDTH ft 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 ft u `i DISPOSAL PONDS WIDTH DISTANCE TO NEAREST SEEPAGE PITS NUMBER 24 DISTANCE TO NEAREST .ft LENGTH ft DEPTH ft WELL it FOUNDATION it PROPERTY LINE ft WIDTH V� bl ft DEPTH ZS ft WELL 150 ft FOUNDATION ]()r ft PROPERTYLINE Sr ft 1 HEREBY CERTIFY THAT 1 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. Application Accepte Final Inspection By Character of Soil to Deptl'1 at 3 COMMENTS S moi l COti Ef S�14 6 3-- DPP,aRTME1LFT USE ONLY nn Date Alre/a Employee ID# Del Cate L�' SPECIAL PERMIT -Approved by Pit/Sump Soil Character: f 7r OJGI v�C'1� rlps1-rD�/locl, �JPoSLIoa.S� �-- 1�ofi e X L F('�itl j nc�l FS G 1l I'» irG�l)I L�IG1�N1[7f,"S 'nt%461; tw P Code �� m 42-01 � ✓`2' ONSITWA TEWATER TRT NT SYST M ERI � �/l lv.S�32—` �� Sc INFO Received B Check#/ Cash Amount Remitted Date Permit/ Service Request # Invoice # Permit ID# OWL � � �s"�j00 1 *2q 92o ' 2r� s (2, (Do 23� — ■■■■■■■■■■■��■■ �■ail■■■■r��r�■■■■■■■■■■■■■sr■■■■■■■ ■.■■■■■■■■■�1■/iia'■■■■I��!■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■ ■■■■■ar■ee■■■■■■�a■►r��■�■■■■��■►■■ ■■■■■■■■■■ ■�1II■■ ■■t■■■■■i�it�fiiil�i�ll�■111■11L1�'Jllt!J,1/■■il � � ■■■■■■■■ ■■ ■■ OEM, ■■■ ■ ■■■■::■ ■■■■■■■■■ ■■■■■■■■■■■■■■■■■:■■■■:■■■■::■■:■: Application Accepte Final Inspection By Character of Soil to Deptl'1 at 3 COMMENTS S moi l COti Ef S�14 6 3-- DPP,aRTME1LFT USE ONLY nn Date Alre/a Employee ID# Del Cate L�' SPECIAL PERMIT -Approved by Pit/Sump Soil Character: f 7r OJGI v�C'1� rlps1-rD�/locl, �JPoSLIoa.S� �-- 1�ofi e X L F('�itl j nc�l FS G 1l I'» irG�l)I L�IG1�N1[7f,"S 'nt%461; tw P Code �� m 42-01 � ✓`2' ONSITWA TEWATER TRT NT SYST M ERI � �/l lv.S�32—` �� Sc INFO Received B Check#/ Cash Amount Remitted Date Permit/ Service Request # Invoice # Permit ID# OWL � � �s"�j00 1 *2q 92o ' 2r� s (2, (Do 23� — /J 4/14/18