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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 Noor -REFUNDABLE PERMIT CALL (209) 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS CROSS STREET `f OWNER NAME wvi++-.15' pea CITY/ZIP C"/% I APN 056 — 1 :7 PARCEL SIZE PHONE OWNER ADDRESS /U CITY/STATE/ZIP CONTRACTOR l j," (/� Ci PHONE CONTRACTOR ADDRESS ♦' Ct CJ/SLi'1 /J" - CITY/STATE/ZIP L�IJ�/�_ LICENSE I 1 \9(42 1 I C-36 OTHER NUMBER EXPIRATION DATE WATER TABLE DEPTH: I ---J ( '(--?U ft GEOGRAPHICAL INFORMATI N: Coordinates X Y 1 PERC TEST # BUILDING PERMIT # — LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION R PAI NEW ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTHER NUMBER OF LIVING UNITS: 4— NUMBER OF BEDROOMS: 1;L NUMBER OF EMPLOYEES: SEPTIC TANK TYPE/MFG L CAPACITY Z BOO gal # OF COMPARTMENTS c;2 ❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS DISTANCE TO NEAREST: WELL 16�7 ft FOUNDATION O ` ft PROPERTY LINE So e 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 WORKERS COMPENSATION LAWS. MINIMUM ' 04 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 SIGNED ��J�`=� TITLE DATE DATE &— /Z '7"Q I r _EPA RTM.E T USE N Y / Application Accepted By Date Area LE Employee ID# Final Inspection BDate ;R��Iltljk ❑ SPECIAL PERMIT - Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS CA PE LEACH LINES LEACHING CHAMBERS Amount emitted # OF LINES �� LENGTH OF LINES s ft Invoice # Permit ID# DISTANCE TO NEAREST WELL l 0Q i ft FOUNDATION So 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 SEEPAGE PITS DISTANCE TO NEAREST NUMBER �2 WELL WIDTH� ft FOUNDATION // ft ft PROPERTY LINE ft DEPTH 945� ft DISTANCE TO NEAREST WELL /S;j /- ' ft FOUNDATION /00, ft PROPERTY LINE o; A 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. MINIMUM ' 04 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 SIGNED ��J�`=� TITLE DATE DATE &— /Z '7"Q I r _EPA RTM.E T USE N Y / Application Accepted By Date Area LE Employee ID# Final Inspection BDate ;R��Iltljk ❑ SPECIAL PERMIT - Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS CA PE SC INFO Receive heck B ash Amount emitted Date Permit/Code Service Request # Invoice # Permit ID# X15 P 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 5/5/17