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ONSITE WASTEWATER TREATIb1ENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTII Uf.PAHTMENT Id68 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 <br /> "-NG',-REFUNDABLE PERMIT CALL(20 53-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS.h. ./_-tlDD Ad __. _CmmP <br /> 'CROSS STREET � APIN PARCEL SIZE <br /> OWNER NAME / I✓&l r I ,S-hq cch T _- _ �.,�PHONE �s//���/70-7 3a)_ <br /> OWNER ADDRESS ^�'ev � _... CITY/S� IP r /Ct�s/10 HT ?J 71 , <br /> CONTRACTOR ` L'L� T-7r i IIP 1 k __ PHONE 0g-9'3�-3043 <br /> CONTRACTOR ADDRESS <br /> AN / r W� OD � _- CITY/STATE/ZIP S(QGIL Cl+ 4s0116 <br /> LICENSE C-42 C-36 OTHER__.__ NUMBER _ EXPIRATION DATE__. <br /> WATER TABLE DEPTH: S`J ft GEOGRAPHICAL INFORMATION: Coordinates <br /> FERC TEST N BUILDING PERMIT# _LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION REPAIRJADDrnoN ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT M DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE t*-C6MMENCt/a-' V,OTHER — <br /> NUMBEROFLIVINGUNITS:. NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES:_ _ <br /> ❑ SEPTIC TANK TYPE/MFG CAPACITY ._ gal If OF COMPARTMENTS_ _ <br /> ❑ GREASETRAP TYPFIMFG CAPACITY gal If OF COMPARTMENTS_ _. <br /> DISTANCE TO NEAREST: WELL _ It FOUNDATION it PROPERTY LINE It <br /> (3 LIFTSTATION SIZE _TYPE OFPUMP__ ❑ PKGTXPLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> O LEACH LINES LEACHING CHAMBERS NOF LINES _ LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL It FOUNDATION it PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH ft LENGTH—__ ft DEPTH _ __It <br /> DISTANCE TO NEAREST WELL----- it fOUNUATION ft PROPERTY LINE _it <br /> ❑ MOUNDED WIDTH it LENGTH__ it DEPTH _ it <br /> DISTANCE TO NEAREST WELL _ ft FOUNDATION It PROPERTY LINE_._. It <br /> ❑ SUMPS WIDTH _ it LENGTH----it DEPTH it <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE_ it <br /> ❑ DISPOSAL PONDS WIDTH__. it LENGTH N DEPTH it <br /> DISTANCE TO NEAREST WELL R FOUNDATION it PROPERTY LINE It <br /> ❑ SEEPAGE PITS NUMBER _ WIDTH It DEPTH it <br /> DISTANCE TO NEAREST WELL it FOUNDATION ft PROPERTY UNE- _ 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 /> AMNRV�OUR ADVANCE-NOTICE REOUIRED FOR INS <br /> P <br /> ECTION <br /> S-PLEASE CALL 209 9537769Z <br /> SIGNED_ - - --- - —. -- TITLI �( ? h;'�` - - ---- DATE - - <br /> ELIE <br /> A <br /> Vic N IR U <br /> -� <br /> a <br /> PLPARTMFNjfP#E0NL <br /> Application Accepted Date _ Area q Employee IDN <br /> Final Inspection By' 9 _ Date l(� ❑ SA <br /> AL PERMIT <br /> -Approved by <br /> Character of Soil to De hof 3 __ _- Pit/Sump Soil Character: <br /> COMMENTS /C. <br /> PE SC Received Chec Amount Date Permit/ Invoice# Permit IDM <br /> Code INFO By Retained Service_ Request If <br /> 5 <br /> G <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 5/5/17 <br />