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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT P <br /> SAN JOAQUIN POUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 <br /> NOI3-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS � + O CITY21P L <br /> CROSS STREET -' a f 1y1 lt'.acr IAV APN�� �/ PARCEL SIZE p <br /> v <br /> OWNER NAME � tt,, 6 �► /��/� L �I/J dra �,T Auer �! PHONE <br /> OWNER ADDRESS �/'TI�I"L�i CITY/STATE/ZIP <br /> CONTRACTOR \i '�C�`t ��- �—A-� PHONE <br /> CONTRACTOR ADDRESS ^ ! .7 °, CITY/STATE/ZIP <I t --4,Adc:to , <br /> LICENSE ❑! C-42 [IFIC-36 OTHER NUMBER - EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: L NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE <br /> F j REPLACEMENT 5 OUT-OF-SERVICE SEPTIC SYSTEM Ll DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE N COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: I NUMBER OF BEDROOMS: .2 NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION __— It PROPERTY LINE It <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES L' LEACHING CHAMBERS _ #,OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> g,.-"FILTER BED WIDTH I".�-__ ft LENGTH "�.4 I ft DEPTH h< ft ft <br /> DISTANCE TO NEAREST WELL_ It FOUNDATION ft PROPERTY LINE Ic)� ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE _ ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN <br /> JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br /> CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br /> WORKERS COMPENSATION LAWS. <br /> MINIMUM 24 YOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL (209)953-7697 <br /> SIGNED TITLE �, � f��II CI r _ DATEVail— <br /> Lzj <br /> T <br /> Ant <br /> D <br /> � � A <br /> ilq N <br /> 117 7j' <br /> RMNT <br /> Vol <br /> < DEPARTMENT US B ONLY ,,�� ''uu,,,,,,,�� <br /> Application Accepted B Date Area Employee ID# �I�v <br /> Final Inspection By Date ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to pth of 3 Ft: P itilkump Soil Character: <br /> COMMENTS ' `11 LQ (/VT--[l-�bn/ ___ ._ <br /> PE Sc Received hec Amount Permit/ <br /> Code INFO B Sh Remitted Date Service Request# Invoice# Permit ID# <br /> z(n l 77 S 9 5'b <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 5/5/17 <br />