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ONSITE WASTEWATER TA A" �JIFNT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 NON-REFUNDABLE PERMIT (:ALL 20J 953 -115911 -OR IPJSPECTIONS tXPIRES 1 YEAR FROM UATE ISSUED JOB ADDRESS _ �CITYIZIP � /2, CROSS STREET lyl APN '`� oO ARCEL SIZE _� `f (� I . n A A ,,„ OWNER NAMETN,_AtllX ra CiI� `� OWNER ADDRESS ��/V\ii PERI•II�_CITY/STATE/ZIP \\ t � CONTRACTOR Yl+cY'b 1 , EXPIRED_ PHONE �V_I l - 2 ?(,_A �`�� CONTRACTOR ADDRESS P d _'p I)X I 1;'q'�7 CITY/STATE/ZIP r / �✓ �/ LICENSE 11, C-42 C-36 OTHER _ / _ NUMBf'H `f((/3l00 sEXPIRATION DATE__ O 0 i WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION I RE=PAIR/ADDITION ENGINEER DESIGNED REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: RESIDENCE I I COMMERCIAL Ll OTHER NUMBER OF LIVING UNITS: _ NUMBER OF BEDROOMS: _ NUMBER OF EM L TERNATIVE ❑ SEPTIC TANK TYPE/MFG CAPACITY gal # OF CfI7SL ❑ GREASETRAP TYPE/MFG CAPACITY gal #OFCOMPARTMENTS p DISTANCE TO NEAREST: WELL ft FOUNDATION _- ft PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP--- ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) 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 CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL V10'PIKERS COMPENSATION LAWS. CA MINIMUM 24 HOUR ADVANCE NOTICE REQUIREQ FOR INSPECTIONS - PLEASE CALL (209) 953-7697 SIGNED TITLE &4 "—' Cal- /1�ATE o� DEPARTMENT USE ONLY Application Accepted By - - Date-- — -- Area �_ Employee ID# AB a Final Inspection By Date Ll SPECIAL PERMIT - Approved 1: j Character of Soil to Depth of 3 Ft: _ Pit/Sump Soil Character: COMZA E NTS Ad_6 r_ ._ 0. c�lrrrrrrr,y;�' f `t°i►^ i�._. 1'L iA�l tA/Lc� (Tie, PE Sc Code INFO Received B hec ash Amount Remitted LEACH LINES ❑ L Permit/ Service Request # # OF LINES �_ LENGTH OF LINES It p C CHAMBERS i[AMMEST WELL—11, VO ft FOUNDATION to .ft PROPERTY LINE ft LlFILTER BED WIDTH - ft LENGTH _ ft DEPTH 54%r ft DISTANCE TO NEAREST WELL ft FOUNDATION - ''+0 ft PROPERTY LINE t LJMOUNDED WIDTH _ ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE w a ft ❑ SUMPS WIDTH __ ft LENGTH _ _ ft DEPTH lea. 1 0 ft DISTANCE TO NEAREST WELL It FOUNDATION _ft PROPERTY41N INS aQU ft lu Ll DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH _ NFAL7-M �j�P�, �� ft DISTANCE TO NEAREST WELL _ It FOUNDATION It PROPERTY LINE RTME ft J SEEPAGE PITS NUMBER_ WIDTH 7 ft DEPTH ft 1 1 DISTANCE TO NEAREST WELL 12-0 _ ft FOUNDATION I V ft PROPERTY LINE 10 ft 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 CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL V10'PIKERS COMPENSATION LAWS. CA MINIMUM 24 HOUR ADVANCE NOTICE REQUIREQ FOR INSPECTIONS - PLEASE CALL (209) 953-7697 SIGNED TITLE &4 "—' Cal- /1�ATE o� DEPARTMENT USE ONLY Application Accepted By - - Date-- — -- Area �_ Employee ID# AB a Final Inspection By Date Ll SPECIAL PERMIT - Approved 1: j Character of Soil to Depth of 3 Ft: _ Pit/Sump Soil Character: COMZA E NTS Ad_6 r_ ._ 0. c�lrrrrrrr,y;�' f `t°i►^ i�._. 1'L iA�l tA/Lc� (Tie, PE Sc Code INFO Received B hec ash Amount Remitted Date Permit/ Service Request # oice # Permit ID# p " 12.1--1 S u j X15 - EXPIRED 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 5/5/17