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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAOUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 IVUN-MLIUNDAHLE VEHMI Fnn (:ALL ZUV 553-/6y/ FO_H_ INSPECTIONS LXPIRES 1 YEAR FROM DATE_ ISSUE JOB ADDRESS BrraOD Erb y` iGO�- CITY/ZIP \�C'af I �i53C►�I _ __ CROSS STREET hAj,r pG1 IL5 . APN i ' '" �'`i �� PARCEL SIZE /- OWNER NAME Ke-Ilf-Va Of I- ,peA& 7-tAA -I Gr Q� PHONE SAND OIL SEPARATOR (ENCLOSED SYSTEM) OWNER ADDRESS 8.200 F- Cb I&JA - CITY/STATE/ZIP C.p_ U►S�JCiU LENGTH OF LINES ft DISTANCE TO NEAREST WELL CONTRACTOR Sat -'Ix ;4^6PHONE ft ❑ FILTER BED WIDTH 2 4-t ft LENGTH QCc'.Ck'"Ab'n CONTRACTOR ADDRESS L7`7- 1 1'��(•� CITY/STATE/ZIP DEPTH ft LICENSE C-42 n C-36 OTHER NUMBER SL:4 -7-S-1 EXPIRATION DATE ft PROPERTY LINE iG ft WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X PERC TEST # BUILDING PERMIT # LAND USE APPLICATI TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGIRT REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM Djk* INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTHER 1 NUMBER OF LIVING UNITS: �_ NUMBER OF BEDROOMS: e 57 NUMBER OF Y TERNATIVE ❑ SEPTIC TANK TYPE/MFG CAPACITY gal # OF COMPARTINLS ❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) ❑ LEACH LINES LEACHING CHAMBERS # OF LINES LENGTH OF LINES ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ FILTER BED WIDTH 2 4-t ft LENGTH 3% ft DEPTH ft DISTANCE TO NEAREST WELL ft OUNDATION ft PROPERTY LINE iG ft ❑ MOUNDED WIDTH ft LENGTH toI ft DEPTH fi DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ SUMPS WIDTH ft LENGTH ft h DEPTH DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE `I t ❑ DISPOSAL PONDS WIDTH —_ ft LENGTH ft DEPTH �?t DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LI ft ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH F 'IQU ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LIN CT NME UN ft HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITHIS"dN 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 COMPENSAJION LAWS. Irm MINIMUM- 4'HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 SIGNED �� TITLE DATE 7- 1-18 �- EPARTMENT SE ON Y Application Accepted By Date Area Employee 0#417W Final Inspection By Date - ❑ SPECIAL PERMIT - Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS I, - I AA 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 5/5/17 T Trig/.•\ 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 5/5/17 T