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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 NON-REFUNDABLE PERMIT �r CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOBADDRESS / eo"Li (j CITY/ZIP G G.� CROSS STREET N U S /' L ^ e 1 I 1 APN C PARCEL SIZE OWNER NAME 11 l ()f SYYI ?rj {,IG11 `� 60 S /I1 ��1f� %PHONE t� OWNER ADDRESS CITY/STATE/ZIP CONTRACTOR��G S `9 Cf4JC&t //!t .5j'? r. PHONE d c� CONTRACTOR ADDRESS j-'7 &-w. I(" CITY/STATE/ZIP � -et Aec-f �c,4 o f LICENSE 1_1 C-42 I I C-36 OTHER NUMBERL06 EXPIRATION DATE jold 11, WATER TABLE DEPTH: IV I rT ft GEOGRAPHICAL INFORMATION: Coordinates X Y PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION RFPAIR/Anr)1T1!1N PKInIhicam r1col-1- )( REPLACEMENT I OUT -OF -SERVICE SEPTIC SYSTEM iC DESTRUCTION L1 11 INSTALLATION WILL SERVE: p ESIDENCE ❑ COMMERCIAL 1 OTHER NUMBER OF LIVING UNITS: I NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: 61 --'SEPTIC TANK ❑ GREASE TRAP ❑ LIFT STATION TYPE/MFG iQ+CAPACITY_•yK,�� gal # OF COMPARTMENTS_____ TYPE/MFG CAPACITY gal # OF COMPARTMENTS DISTANCE TO NEAREST: WELL %#t`FOUNDATION J t It PROPERTY LINE 4a ft SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) @--'LEACH LINES LEACHING CHAMBERS # OF LINES LENGTH OF LINES j, I ft Date DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE I4 ft ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION It 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 JtlT ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH It DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERT INE "L. 2818 It ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH�OAQ(q , — ft DISTANCE TO NEAREST WELL ft �M�� N ft FOUNDATION ft PROPER�c& Y -v �NN I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITHrSAN 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 COMPENS ON LAWS. MINIMUM HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 SIGNED TITLE_CDrt t-C43r DATE -7 1'1 DEPARTMENTUSE ONLY C/� // Application Accepted B Date -1 _ Area V ) CGI Employee ID# A h w'? �/ Final Inspection By Wrim, Date ❑ SPECIAL PERMIT - Approved by Character of Soil to Depth of 3 Ft: Pit/SurT!p Soil Character: COMMENTS I r Pr �,� t /)IT C+ c1 PE Code SC INFO Received B -CheakW ash Amount Remitted Date Permit/ Service Request # Invoice # Permit ID# 1 p L/ ' 0 () `I �d' 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 5/5/17 Ai m Y C C A R7