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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 CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS 1-21- 15- CITY P � U G�qm CROSS STREET 1 \ >nI APN " d PARCEL SIZE r �' OWNER NAME J1�S� Cry{/ CT7O ' P H 0 N E Q7P2 Z[if".--gL5 OWNER ADDRESS / CITY/STATE/ZIP CONTRACTOR ♦� 'L✓(�!7�'�--/- PHONE 2-18 3 a6�7 CONTRACTOR ADDRESS p t0 'K �� .VeT�/ --CITY/STATE/ZIP I olrc� it LICENSEf( C-42 I-) C-36 OTHER NUMBER 839 S`{S EXPIRATION DATE WATER TABLE DEPTH: a ft GEOGRAPHICAL INFORMATIO COOrdln teS X Y LJ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: NEW INSTALLATION I ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: <RESIDENCE U COMMERCIAL Ll OTHER NUMBER OF LIVING UNITS: \ ANUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: 06- SEPTIC TANK TYPE/MFG ,PA CAPACITY _L gal #OF COMPARTMENTS !� ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) _......_......................_..._......................_..........__._._._.__.._............._._____.__._ __.. ...___ _ LEACH LINES .0 LEACHING CHAMBERS r #OF LINES LENGTH OF LINES 7 ft DISTANCE TO NEAREST WELL 10 O 'f- ft FOUNDATION It + ft PROPERTY LINE S + ft ❑ FILTER BED WIDTH ft LENGTH It DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ MOUNDED WIDTH ft LENGTH It DEPTH Yl�9ea- ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE JyP • ft ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY((LII��N��EAUX p ft El DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH "W./n. 1O ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERT UI,,NCn— ft SEEPAGE PITS NUMBER WIDTH Tf — It DEPTH tyFN�T ft DISTANCE TO NEAREST WELL 100 4- ft FOUNDATION �� f ft PROPERTY LINE 7 ��N� 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 COMPENS^ ION LAWS. MINIMU f1+HQL1ffADVANCg NOTICE 6EQUIRED FOR INSPECTIONS-PLE4SE CALL 209 953-7697 SIGNED TITLE BL-?'k/L c6 ATE 00- 7�I r to 4 1r7 6 1 1 1 10 Of O 0 1 -DIP A R T M E N TU E VNLY Application Accepted By Date [ Area Employee ID# Final Inspection By Date le) /3 7�' ❑ SPELL P RMIT-Approved by Character of Soil to pth o 3 F. Pit/Sump Soil Character: COMMENTS PE SC Received k#/ Amount Permit/Code INFO B Cas emitted Date Service Request# Invoice# Permit ID# 3000 9-- M11 L4 go) 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 5/5/17