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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JO:,QUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 NT%q-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED 'OB ADDRESS 25 8/ (- A/ r �T 19 [ j=,�,�t�C�C !�-b CITY/ZIP A-CAI" P 0 C15— f� CROSS STREET HW Y t O((,l EFL IZD APN 005 390 S el PARCEL SIZE r OWNER NAME E pr1JCP O^^n PHONEaO--i � OWNER ADDRESS S /r 1 l CITY/ST'ATE/ZIP CONTRACTOR PHONE CONTRACTOR ADDRESS CITY/STATE/ZIP LICENSE I I C-42 I C-36 OTHER NUMBER EXPIRATION DATE WATER TABLE DEPTH: J ft GEOGRAPHICAL INFORMATION: Coordinates X Y i PERC TEST # BUILDING PERMIT# . U /S LAND USE APPLICATION# TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE 7( REPLACEMENT T(,AKf OUT-OF-SERVICE SEPTIC SYSTEM X DESTRUCTION 7-4,1 K INSTALLATION WILL SERVE: .J RESIDENCE rA COMMERCIAL Ll OTHER NUMBER OF LIVING UNITS: NU B BEDROOMS: S NUMBER OF EMPLOYEES: n SEPTIC TANK TYPE/MFG P �L L CAPACITY 2—(906) gal #OF COMPARTMENTS ❑ GREASE TRAP TYPE/MFG CAPACITY / gal #OF COMPARTMENTS DISTANCE TO NEAREST: WELL S�U ft FOUNDATION 1G''� ft PROPERTY LINE I'< ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) Gal LEACH LINES LEACHING CHAMBERS #OF LINESLENGTH OF LINES S S - ft DISTANCE TO NEAREST WELL U ft FOUNDATION �G {y' ft PROPERTY LINE �G 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 NEAR E (WELL ft FO'UfNDA;)N ft PROPERTY LINE ft SEEPAGE PITS NUMBER S WIDTH L4 )- ft DEPTH .0 S ft DISTANCE TO NEAREST WELL Q ft FOUNDATION Lj ft PROPERTY LINE SG 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 COMPENSAIJON LAWS. MINIMUM HOUR AD CE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL (209)953-7697 SIGNED -TITLE l.t/ P 1' DATE L' J J � M N 11 DEPIt— ARTMENTUSEONLY Application Accepted B,�yq, Date " ,�' y Area y /� 9 Employee ID# �tJ U� Final Inspection By/L�! Z2 0� Datey//71f7 [I SPECIAL PERMIT-Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS $ 22 e, S Jai ff a rij-e.—O � f t cf�Cl t� PE SC Received Check#/ Amount Permit]Code INFO B Cash Remitted Date Service Request# Invoice# Permit ID# •L LI 5 Crec) q�( 00- 2 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 5/5/17