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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAR JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 IVUN-MEI•UNDABLEE FERMIT INSTALLATION WILL SERVE: RESIDENCE ZUW 953-7697 FOR INSPECTIONS 1 EAR FROM DATE ISSUEI JOB ADDRESS 7 SO / /GALL /LJ JON_ _ N CITY/ZIP lEXPIRES CROSS STREET ` ';, _ ft FOUNDATION �J ft PROPERTY LINE 4,_ _ ft Q APN / /�pQ/ / PARCEL SIZE 4� !%C OWNER NAME/PJHO'N'EA __. _ ._ .__.._ __... _1-1-_-_'.-- 1-1 -...__.._... ______._ _-----._ 7 t # OF LINES 6 LENGTH OF LINES 19.2 ft DISTANCE TO NEAREST WELL //y ft FOUNDATION 6_9 ft PROPERTY LINE L1 ft OWNER ADDRESS / y]��jQA/ CITY/STATE/ZIP t 1 /A - /�//UCI�VV , LH. 9s1936 CONTRACTOR �CJ'///��C_ ft DEPTH ft PHONE 7—O9 VZ J— Q1J3 CONTRACTOR ADDRESS �j / ///� 0/V _ _CITY/STATE/ZIP �/� t 1 hN Y_93� LICENSE 13CC-42 A-4-36 OTHER ❑ DISPOSAL PONDS WIDTH ft LENGTH NUMBER 17/2 EXPIRATION DATE 3 [ I 7 WATER TABLE DEPTH: _�3 ft GEOGRAPHICAL INFORMAT N: Coor inates X Y PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: RESIDENCE LI COMMERCIAL L OTHER NUMBER OF LIVING UNITS: I NUMBER OF BEDROOMS: S NUMBER OF EMPLOYEES: SEPTIC TANK TYPE/MFG _ CAPACITY MoD gal # OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS DISTANCE TO NEAREST: WELL _ _ ` ';, _ ft FOUNDATION �J ft PROPERTY LINE 4,_ _ ft ❑ LIFT STATION SIZE TYPE OF PLIMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) _.... ......... - -- _ .. _._. ...... LEACH LINES LEACHING CHAMBERS __. _ ._ .__.._ __... _1-1-_-_'.-- 1-1 -...__.._... ______._ _-----._ 7 t # OF LINES 6 LENGTH OF LINES 19.2 ft DISTANCE TO NEAREST WELL //y ft FOUNDATION 6_9 ft PROPERTY LINE L1 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 CCR e iv ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH L , /fft �Uzw DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY Li$l% ft 13SEEPAGE PITS NUMBER WIDTH ft DEPTH ENV/ UINCN ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE %/OEP„�n 7"It ft ® --- - f 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 CALIFORA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL WORKERS COMPENSATION LAWS. / SIGNED W-/ / TITLE 1,4V.tJhe / / 7,0,_0?C'17D4L DATE Application Accepted By Final Inspection By �i ` y '' r ll Character of Soil to epth of 3 Ft: COMMENTS n Date 7¢ Date 1%<_ ISE ONLY 7 Area Employee ID# u w� 1 g�Sr' fell SPECIAL PERMIT - Approved by Pit/SS Soil Character: PE Code Sc INFO Received Cash Amount em' ed Date Permit/ Service Request # Invoice # Permit ID# -20-�ULZ 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 5/5/17