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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 959n5 - 1gnQ1 Aau_zAjn r-rh lI I wim-1 ]rFUIYI'-, Sc INFO (:ALL ZU9 953-7597 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUE) J le ADDRESS-�1V D �UY CITY/ZIP S Permit ID# CROSS STREETI v J % APNy7 SV 7 �` PARCEL SIZE OWNER NAME yzI1 OWNER ADDRESS O Q 1 ' CITY/STATE/ZIP ww(_ `PPHO\NEE I )1 gs-3VO ("Q CONTRACTOR PHONE CONTRACTOR ADDRESS CITY/STATE/ZIP LICENSE i C-42 C-36 OTHER NUMBER EXPIRATION DATE WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: CO r ina s X Y PERC TEST #._ BUILDING PERMIT # AND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION RE AIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE J REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM ❑ DESTRUCTION INSTALLATION WILL SERVE: J)RESIDENCE [I COMMERCIAL I1 OTHER NUMBER OF LIVING UNITS: I NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: �f SEPTIC TANK TYPE/MFG CAPACITY gal # OF COMPARTMENTS Z ❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS 0 DISTANCE TO NEAREST: WELL _I U U ft FOUNDATION O �� ft PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) LEACH LINES LEACHING CHAMBERS # OF LINES 22 LENGTH OF LINES ft DISTANCE TO NEAREST WELL Ij t ft FOUNDATION A O 'f ft PROPERTY LINE ft ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE ft ❑ MOUNDED WIDTH ft LENGTH It DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY ft ❑ SUMPS WIDTH It LENGTH It DEPTH y„� ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERT �9 ft ❑ DISPOSAL PONDS WIDTH ft LENGTH It DEPTH '® _ ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPER L ft ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft DISTANCE To NEAREST WELL It FOUNDATION ft P / ppC�N� ft I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDaIkdEI#ITH 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- 697 t_ �- ✓ SIGNED TITLE. - DATE DEPARTMENT.A)SE NLY Application Accepted By ` Date Z rrp (�V Employee ID# Final Inspection By n(4�r i`'�t,11Sk6' Date I v75 a e�'� �' LI JSP AL PE MIT - Approved by Character of Soil to Depth of 3 Ft: PIUSump Soil Character'. COMMENTS 0 �/�.1 Z �f� i✓..� ISM �.r! Sr a !I in= i RrU A zap[ PE Code Sc INFO Received hec ash Amount Remitted, Date Permit/ ervice Re uest # Invoice # Permit ID# 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 5/5/17