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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 RINSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUE[ JOB ADDRESS 4/ .�TCIr /ZIP O _ CROSS STREET L/Ir��' , cs� ,,/� APN L 010- / P-9--7 PARCEL PARCEL SIZE�1 /Y�t y OWNER NAME �' epi Z�zr✓ /T l OT -Q i"n , (PHONE e�1T-3.;L -—C,(OY7 OWNER ADDRESS Pf-O .�V It L�` 4lJ I ____CrrY/STATE/ZIP rT7 fi,!__ �j'i 7 CONTRACTOR 7'N/ t/4 "'N�/ hL PHONE zwy- x19-5-02 CONTRACTOR ADDRESS 3 �/( ClTio �+ //'^ CITY/STATE/ZIP l w/. M LICENSE ❑x-42 11C-36 OTHER __ NUMBER EXPIRATION DATE 0 - I ! WATER TABLE DEPTH: __ it GEOGRAPHICAL INFORMATION: Coordinates X Y G PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION %`, REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT OUT -0F -SERVICE SEPTIC SYSTEM DESTRUCTION INSTALLATION WILL SERVE: RESIDENCE I I COMMERCIAL. L OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ SEPTICTANK TYPE/MFG Cit/A-v 1'.404CAPACITY gal #OF COMPARTMENTS ❑ GREASETRAP TYPE/MFG CAPACITY gal If OF COMPARTMENTS DISTANCE TO NEAREST: WELL it FOUNDATION ft PROPERTY LINE ft ❑ LIFT STATION SIZE -- TYPE OF PUMP O PKGTX PLANT O SAND OIL SEPARATOR (ENCLOSED SYSTEM) 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. SIGNED TITLE. DATE 4 Application Accepted By ~ Date Area 2Area -X4— Employee ID#� Final Inspection By ale i ❑ SPECIAL PERMIT -Approved by Character of Soil to D h o Pit/Sump Soil Character: _ COMMENTS �a4-r-► /nrG /�/1 PE SC Received Amount Date PermiU Invoice # Permit ID# Code INFO s Remitted Service Request !!#1 oD00 1 V 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 5/5/17 �s'iI LEACH LINES LEACHING CHAMBERS # OF LINES LENGTH OF LINES it DISTANCE TO NEAREST WELL /—_-ft FOUNDATION S?1� it PROPERTY LINE �aO� ft ❑ FILTER BED WIDTH ft LENGTH ______ ft DEPTH ft DISTANCE TO NEAREST WELL it FOUNDATION it PROPERTY LINE �it w ❑ MOUNDED WIDTH ft LENGTH h �' DEPTH rtt DISTANCE TO NEAREST WELL R FOUNDATION it it PROPERTY LINE—�—� El SUMPS WIDTH it LENGTH ft _' DEPTH "'-'}r L n "lrl�-it DISTANCE TO NEAREST WELL ft FOUNDATION it PROPERTY LINE " - it ❑ DISPOSAL PONDS WIDTH ft LENGTH it DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION _ h PROPERTY LINE ft SEEPAGE PITS NUMBER__ WIDTH S7, ft DEPTH �5� ft / ` DISTANCE TO NEAREST WELL ISO it FOUNDATION SO ft PROPERTY LINE BOG f 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. SIGNED TITLE. DATE 4 Application Accepted By ~ Date Area 2Area -X4— Employee ID#� Final Inspection By ale i ❑ SPECIAL PERMIT -Approved by Character of Soil to D h o Pit/Sump Soil Character: _ COMMENTS �a4-r-► /nrG /�/1 PE SC Received Amount Date PermiU Invoice # Permit ID# Code INFO s Remitted Service Request !!#1 oD00 1 V 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 5/5/17