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ONSITE WASTEWATER TREATMENT SYSTEM. PERMIT P - r <br />SAV UAQUiN COUNTY ENViRONMENTAL HEALTH DEPARTMENT 7868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 <br />NON-REFUNDABLE PERMIT / GAL 209 953-7697 FOR INSPECTIONS XP ES 1 YEAR FROM DAT ISSUE[ <br />6 <br />JOB ADDRESS �'3� QS r_ r11 e '� / CITY/ZIP <br />CROSS STREET `' r ,` APN 1Iw PARCEL SIZE <br />OWNER NAME t 6 L <br />f L 'Amnar 14 K 'r PHONE <br />• <br />q WNER ADDRESS 1309 -S, d ` k ff ITY/$TATE/ZIP n l 4 5,Q0 J <br />CONTRACTOR PHONE <br />CONTRACTOR ADDRESS _—CITY/SATEALIAMIT <br />LICENSE 1 1 C-42 I I C-36 OTHER NUMBER EXPI,I �)XAJP Y fJ ' ■ ■ <br />WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br />IJ PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # <br />TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIG ED/ALTERNATIV <br />REPLACEMN OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION <br />INSTALLATION WILL SERVE: ARESIDENCE ❑ COMMERCIAL ❑ OTHER <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br />❑ SEPTIC TANK <br />❑ GREASE TRAP <br />❑ LIFTSTATION <br />TYPE/MFG <br />TYPE/MFG <br />DISTANCE TO NEAREST: WELL <br />SIZE TYPE OF PUMP <br />CAPACITY <br />CAPACITY <br />ft FOUNDATION _ <br />❑ PKG TX PLANT <br />gal # OF COMPARTMENTS <br />gal # OF COMPARTMENTS <br />ft PROPERTY LINE ft <br />❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />❑ LEACH LINES I LEACHING CHAMBERS <br />SC <br />Received <br />B <br /># OF LINES <br />DISTANCE TO NEAREST <br />WELL <br />IMUR <br />ft <br />FOUNDATION <br />❑ FILTER BED WIDTH <br />ft <br />LENGTH <br />ft <br />DISTANCE TO NEAREST <br />WELL <br />1VjA1r1Z1J <br />It <br />FOUNDATION <br />❑ MOUNDED WIDTH <br />ft <br />LENGTH <br />It <br />DISTANCE TO NEAREST <br />WELL <br />ft <br />FOUNDATION <br />❑ SUMPS WIDTH <br />ft <br />LENGTH <br />ft <br />DISTANCE TO NEAREST <br />WELL <br />ft <br />FOUNDATION <br />❑ DISPOSAL PONDS WIDTH <br />ft <br />LENGTH <br />It <br />TANCE TO NEAREST <br />WELL <br />ft <br />FOUNDATION <br />❑ SEEPAGPEA. <br />WIDTH <br />PpISTANC EAREST <br />WELL <br />ft <br />FOUNDATION <br />LENGTH OF LINES ft <br />ft PROPERTY LINE w ft <br />DEPTH117 <br />ft PROPERTY LINE <br />DEPTH <br />ft PROPERTY LINE /' ��ff eft <br />DEPTH %ill . 2(/iD ft <br />ft PROPERTY� A( V/ ft <br />DEPTH DF FNj ft <br />ft PROPERTY LINE MEAr� ft <br />DEPTH •� ft <br />ft PROPERTY LINE It <br />1 HEREBY CERT F? ThAf EPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN <br />JOAQUIN COUNTY ORDINANCES, TATE 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 COMPENSATION LAWS. <br />I MUM H UR ADVANCE NOTICE REQUIRED FOR INSPECTIONS_J-- PLEASE CALL(209) 53-7697 <br />SIGNED 1 �— TITLE Y C tel'` DATE V C! Q� ^ r °i <br />aii�PARTMENT VSE VNLY <br />Application Accepted By Date Area Employee ID# <br />Final Inspection By Date ❑ SPECIAL PERMIT -Approved by <br />Character of Soil tp Depth of 3 Ft: Q PittSump Soil Character: <br />COMMENTS <br />PE <br />CodeINFO <br />SC <br />Received <br />B <br />Check#/ <br />ash <br />Amount <br />emitted <br />Dqte Permit/ <br />Service Request # <br />IMUR <br />IFFmit ID# <br />I- <br />7--7-- S'J <br />1VjA1r1Z1J <br />. <br />42-01�'C7� Q�Cj��� ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />5/5/17 O <br />T <br />z <br />