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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT P- I SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 PION-KEFUNDABLE PERMIT G 64----v ALL Z /UY 953 -✓1697 FOR INSPECTIONS EXPIR S 1 YEAR FROM DATE ISSUED JOB ADDRESS 2 l4/ � tt' Loo `C•J/CITY/ZIP C AY, 1 CROSS STREET «� APN —Z� '�-1� PARCEL SIZE (J i-7 OWNER NAME Z -OWNER ADDRESS TY/STRIP • lJ �/ G. CONTRACTOR �' ` PHONE Z Z> CONTRACTOR ADDRESS <'e2%✓/� CITY/STATE/ZIP �Z LICENSE I I C-42 I I C-36 OTHER NUMBER XPIRATION DATE WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: C PERC TEST # BUILDING PERMIT # TYPE OF WORK: NEW INSTALLATION REPAIR/ADC tes X Y LAND USE APPLICATION # ENGINEER DESIGNED /ALTERNATIVE REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: C RESIDENCE 4 COMMERCIAL OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPE/MFG CAPACITY gal # OF COMPARTMENTS ❑ GREASETRAP TYPE/MFG � �-y� CAPACITY J v gal # OF COMPARTMENTS LENGTH OF LINES ft Permit ID# at-15"�7 DISTANCE TO NEAREST: WELL FOUNDATION ft PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) ❑ LEACH LINES LEACHING CHAMBERS Received B Check#/ Cash # OF LINES Date LENGTH OF LINES ft Permit ID# DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE 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 ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ DISPOSAL PONDS WIDTH ft LENGTH ft 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. SIGNED Application Accepted Final Inspection By_ Character of Soil to D COMMENTS Du' 2 L_ 'OR INSPECTIONS - PLEASE CALL (; TITLE Y 0(4/4XV2 DA 1 T— /F TMENT USE O Y /� Date Area a -L Employee ID# Date ❑ SPE IAL PERMIT -Approved by _ PiU ump Soil Character: r PE Code SC INFO Received B Check#/ Cash Amount Remitted Date Permit/ Service Request # Invoice # Permit ID# `S b I� S2.L�?9 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 5/5/17