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03/20/2017 11:03 2095772499 AAA BACKHOE SERVICE PAGE 01/02 <br />-�;hH.� -;-Io -1`7 <br />ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMRNTAI. HEALTH DnPARTMIINT 600 E MAIN STRERT. STOCKTON CA 06202 -(200)480.3420 <br />rEKMII <br />Jon ADDRIMS <br />CR0$STREET_„1`Yfir� nn� APN. SR103`-I PARCEL SME.163X <br />OWNERNAME T- PHONE <br />OWNER ADDRESS `` CITYISTATEIZIP nn <br />CONTRACTOR �� �(rjG L :I 3 P ry I r? — PHONE <br />CONTRACTOR Aloonw: LLLE 13 (/ 1t��"i �-a-I h-A(,Lp CITYISTATEIZIP r'(Z'}0A?, ,f6 <br />LICPN$P. QC -42 A1C -30 OTHER NUMBER ] 1 !20; pXPINATION DATE <br />WAT@R TADLE DEPTH: _ <br />_ 0 GEOGRAPHICAL INFORMATION: Coofdlnatos X Y <br />Cl PERC TEST A <br />BUILDING PERMIT # <br />DI$TANCEToNEAREST WELL <br />_ LAND USE APPLICATION # <br />TYPE OF WORK: <br />LI NEW INSTALLATION <br />ok VIIA.-nd <br />P ENOIN NE <br />P0 <br />DI9TANCG TO NEAREST WELL <br />❑ REPLACEMENT <br />❑ MOUNDED <br />DESTRUCTION <br />INSTALLATION WILL <br />SERVE! ;'l RFa1n13NC9 <br />❑ COMMERCIAL <br />❑ O R <br />NUMBER OF LIVING UNIT$: _ NUMBER OF BFDROOMS. , <br />r,_,,,_., NUMBER OF EMPLOYEEa: <br />❑ SEPTIC TANK <br />TVPE/MFA <br />CAPACITv . <br />®AI # OF CONPARTMENTa <br />0 GREASE TRAP <br />TYPE/MFG <br />CAPACITY _ <br />pel m of COMFAR7MENTl; <br />ft POUNDAnoN _ ft PROPERTY LINE R <br />DISTANCE TO NEAREST: WELL <br />R FOUNDATION <br />R PROPERTY LINE R <br />❑ LIFTSTATION <br />SIZE .TYPE OF PUMP <br />❑ PKG TX PLANT Cl 9AND OIL SEPARATOR (ENCLOSED SYSTEM) <br />0 LEACH LINES <br />ID LEACHING CHAMBERS <br /># OP LIMES I.FNGTH OF LINEA It <br />InvolcnW PermltlD# <br />DI$TANCEToNEAREST WELL <br />ft FOUNDATION N PROPERTY LINE R <br />0 FILTER BQD <br />MOTH R LENGTH <br />R DEPTH ft <br />DI9TANCG TO NEAREST WELL <br />it FOUNDATION _ R PROPERTY LIN@ R <br />❑ MOUNDED <br />WIDTH ft LENGTH <br />R DEPTH R <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION _ ft PROPERTY LINE_ fl <br />❑ SUMPS <br />WIDTH fl LENGTH <br />i; DEPTFI ft <br />DISTANCE To NEARERT WDLL <br />R FOUNDATION R PROPERTY LINE ft <br />O DISPOSAL PONDS WIDTH TI LFNt;TH <br />R DEPTH _ R <br />DI5TANCG TO NHAREaT WELL <br />ft POUNDAnoN _ ft PROPERTY LINE R <br />Q SEEPAOEPITS <br />NUMBER WIDTH <br />fl DEPTH fl <br />DISTANCE TO NEARERT • WELL <br />R FOUNDATION Yf'” PRBPERTY LINE ft <br />I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br />STAT@ LAWS AND RULER AND <br />REGULATIONS OF BAN JOAQUIN COUNTY. <br />M1101MU H U VA NOTICE REQUIRED <br />FOR INSPECTIONS - PLEASE CALL. (2011063-7697 <br />SIGNED (i1/ <br />424 <br />I// (LY <br />TITLE IQ DATE <br />Application Accnptod�F y Dine <br />Final Inspection By I — L DRte <br />Character of Soil to DoPth of J Ft; <br />COMMENTS �r7/cs ,�✓�t�s<�� <br />AreEmployee IDA <br />IT - . <br />�_ f_I 5PE IAL P Approved by <br />Soil ChAfacter: <br />cErvEo <br />R 2 0 2011 <br />MENTgL HEALTH <br />PAYMENT <br />RECE'IVIEID <br />4AR 2 0 2017 <br />JOAQUIN COUNTY <br />PE <br />GOda <br />3C Rncnlvod <br />INFO <br />Check* Amount Dat Pnrmltl <br />CeSh f}Amltted Service Itegdost # <br />InvolcnW PermltlD# <br />L 11 <br />Received Time Mar.20, 2017 11:18AM No,1065 <br />ONSITE WASTOWAtER TRTMNT SYSTEM PERMIT <br />