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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 J CALL 209 953-7697 FOR INSPECTIONS / EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS J 7�/�> J1LitJGu �Ylr / —CITY/ZIP CROSS STREET we K APN�(�/"�3 3 / PARCEL SIZE p d 01T OWNER NAMEr1i2_71b Jr� Cs tJ PHONE OWNER ADDRESS 2/1 v L� CITY/STATE/ZIP CONTRACTOR �Gi_z/" //�JFJLi�c_Lt �Gr7C PHONE 369'- VOZ/7, 1� CONTRACTOR ADDRESS SSS. D� n✓L CITY/STATE/ZIP /1J� LICENSE f�42 TIC-36 OTHER NUMBER S 5V_5_ EXPIRATION DATE 621 WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y I PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION I ENGINEER DESI "fI�ii/� REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM I i DESTRUCTION �+�.��VV�� INSTALLATION WILL SERVE: V,,RESIDENCE 1.1 COMMERCIAL U OTHER NUMBER OF LIVING UNITS: 1 NUMBER OF BEDROOMS: 37 NUMBER OF EMP S: ❑ SEPTIC TANK TYPE/MFG Sf7wt CAPACITY gal #OF CO '�� COUNTM ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF CO!ARTIv1EN15p%TM TEN 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 I I LEACHING CHAMBERS #OF LINES LENGTH OF LINES �% ft DISTANCE TO NEAREST WELL ft FOUNDATION % ft PROPERTY LINE I�2 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 It DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ DISPOSAL PONDS WIDTH It LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft SEEPAGE PITS NUMBERWIDTH ft DEPTH 5 ft DISTANCE TO NEAREST WELL l SG ft FOUNDATION Ald ft PROPERTY LINE ly It 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. MINIIAUM 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 SIGNED _� TITLE DATE Na 1 121 A Vk I I I IN A M PARTMENT NSE N A Application Accepted By Date Area ��` Employee ID# /� Final Inspection Bye^^/ Date l CI SPECIAL PERMIT-Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS17-9" Aj 446*C~Vn/ PE Sc Received Check Amount Permit) Code INFO B emitted Date Service Request# Invoice# Permit ID# ((S Qo 3 5 3 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 5/5/17