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ONSITE WASTEWATER TREATMENT SYSTE110 PERMIT -P /' SAN JOAQUI14 COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 NGN-REFUNDABLE PERMIT Q CALL(209)953-7697 FOR IIVSPECTIONS EXPIRES 1 YEAR RR}FROOM DATE ISSUED JOB ADDRESS _ (zo to` ii L- CITYR �/�W � IP �C�� GQ CROSS STREET Gni APN �� Q Y PARCEL SIZE-- a OWNER NAME 1^��_C_�L �lG� V��L Q �j� -- ------P.H2ONE OWNER ADDRESS t7-col • LLMC 1 �� __CITY/STATE/ZIP CONTRACTORG• L♦ 'M-0� PHONE ?O7- 477 CONTRACTOR ADDRESS ' L "U1� v��+ _ _ —CITY/STATE/ZIP LICENSE [I C-42 ❑ C-36 OTHER—G NUMBER'r-AA441 1EXPIRATIONDATE 7A31 1 Z0 z-o 1 WATER TABLE DEPTH: 3 ft GEOGRAPHICAL INFORMATION: Coordinates X Y _ FCI PERC TEST # BUILDING PERMIT# J:JoLt2�j% LAND USE APPLICATION# PP-l TYPE OF WORK: 3< NEW INSTALLATION I REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT I J OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: ❑ RESIDENCE -4�,COMMERCIAL I OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: /y w SEPTIC TANK TYPE/MFG _ - CAPACITY 17,-7sV gal O COMPARTMENTS GREASE TRAP TYPE/MFG CAPACITY _ _ gal #OF COMPARTMENTS DISTANCE TO NEAREST: WELL It FOUNDATION ft PROPERTY LINE It L LIFT STATION(4-) SIZE � TYPE OF PUMP.0jW6D ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft ff�\ DISTANCE TO NEAREST WELL ft FOUNDATION � ft PROPERTY LINE L�;O�I t ft ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINEft ❑ MOUNDED WIDTH ft LENGTH ft DEPTH It DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ SUMPS WIDTH __. ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ DISPOSAL PONDS WIDTH ft LENGTH It DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE _ ft ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION _ ft PROPERTY LINE 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 WORKERS COMPENSATION LAWS. MINIMU&E2410WW A VANC OTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 SIGNED _ TITLE DATE 2 Zv OHL- E 3 T D P U. �EPAR—TM—E�NTT- SE N Y Application Accepted y� Date !i Zb Area _ �J Employee ID445 __ Final Inspection By ,C�.1�21� lhCL- Date El❑ SPE ,AL PE MIT-Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMFNTS -s ,4 -e -see g,6"cf-of G.wnsJd � 1..,• PE SC Received Check#/ Amount Permit/ Code INFO B Cash Remitted Date Service Request# Invoice# Permit ID# L 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 5/5/17