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. 1 4 ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SPN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 NOIt-nEFUNDABLE PERMIT Z4-3 0 CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED .IOBADDRESS MJ; (^ �� I DC"J CITY/ZIP L-4 NJ L-/:� rl CROSS STREET w APN T PARCEL SIZE p OWNER NAME Fel �� J f h�� f `� PHONE v�f OWNERADDRE` 1SSXt"��.�` �� D /d��j CITY/STATE/ZIP ' �� SL-10 V CONTRACTOR Wal I L,>^J -TVsAo-' A,3 I,V L PHONE 20C - y CONTRACTOR ADDRESS V3 Me.--i-tri ek S CITY/STATE/ZIP Lo� y�K CA Li 0 LICENSE 1 II C-42 (] IC-36 OTHER -A - NUMBER EXPIRATION DATE Z1i w WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMA47_TION' COordin es X Y2;4 L 1 PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# TYPE OF WORK: NEW INSTALLATION i i REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: �K RESIDENCE I COMMERCIAL ,q 0 OTHER 4 NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: U' SEPTIC TANK TYPE/MFG r CAPACITY , gal #OF COMPARTMENTS V ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS �r DISTANCE TO NEAREST: WELL ft FOUNDATION It PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) ❑ LEACH LINES )t, LEACHING CHAMBERS ) +=t 1tt�J #OF LINES _ LENGTH OF LINES S ft DISTANCE TO NEAREST WELL J JJ ft FOUNDATION J ft PROPERTY LINE t e ire 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 NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ SEEPAGE PITS NUMBER -'s WIDTH ��i ft DEPTH ZS ft DISTANCE TO NEAREST WELLIC C ft FOUNDATION 10 It PROPERTY LINE -� '*" 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 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS I-PLEASE CALL 209 953-7697 SIGNED TITLE t ir✓ DATE -7 J �1 401 i R11" X-ABOL 71. i ! I COUNT( L H 4H If A RTMENk U E NLY Application Accepted B Date Area Employee ID#� Final Inspection By Date ISPECIAL PERMIT-Approved by Character of Soil to Depth of 3 F: Pit/Sump,{SoiI Character: COMMENTS A n2 i&j��17AI n&4r;59UA!Ml I&M-04 Aer zdr-f== PE Sc Received Check#/ Amount Date Permit/ Invoice# Permit ID# Code INFO By Casam t1Ad y Service Reguest# i 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 5/5/17