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Application Accepted By ' LXV L Final Inspection By�i1- Character of Sall to Depth of 3 COMMENTS (J I S n Cr IT- --L_6�j- -; DEPARTMENT USE ONLY �, r Date Area_C1 Employee ID#� Date 7- I I _ SPECIAL PERMIT - Approved by _ Pit/Sump Soil Character: AGI/?r('6' ,-/ 47tv ' q, -,r"- - � rC, e. j LI PE SC r f—I'ja Z LLI Z N 01 SAN JOAQUIN COUNTY ENVIRONMENT L HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 0 C= Z JOB ADDRESS ✓ S d Vl QTY/ZIP 1 C/t- LLI Deur ii es go C'd PARCEL$(�RE�� OWNER NAME5C Q Application Accepted By ' LXV L Final Inspection By�i1- Character of Sall to Depth of 3 COMMENTS (J I S n Cr IT- --L_6�j- -; DEPARTMENT USE ONLY �, r Date Area_C1 Employee ID#� Date 7- I I _ SPECIAL PERMIT - Approved by _ Pit/Sump Soil Character: AGI/?r('6' ,-/ 47tv ' q, -,r"- - � rC, e. j LI PE SC Received Check#/ Amount ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENT L HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR /NsPEcnoNs EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS ✓ S d Vl QTY/ZIP 1 C/t- CROSS STREET Deur ii es go C'd PARCEL$(�RE�� OWNER NAME5C `,_'APN ra / / 7p l `^' 1 11', G rn' 0w/� n See A b �f OWNER ADDRESS _ QTYMrATdZw CC,1 '^ kg ( U'f t( I '/J/-f�J CONTRACTOR ( PHONE 1;O CONTRACTOR ADDRESS ;L3( (e O 1 Soh j , _ CrrY/SYATEMP ��\ LICENSE XC -42 C-36 OTHER NUMBER / 'SSE%PIRATON DATE WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y__ _ PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE REPLACEMENT OUT-OF-SER�N'C� EE SEPTIC SYSTEM DESTRUCTION _ INSTALLATION WILL SERVE: RESIDENCE COMMERiva XOTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS:6Y)`NUMBER OF EMPLOYEES: LlSEPTICTANK TYPEIMFG E SI7 C.oH CAPACITY /61027gal #OFCOMPARTMENTS P^'} ❑ GREASETRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP _ ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) LEACH LINES LEACHING CHAMBERS' # OF LINES _„ — LENGTH OF LraES Ta ft DISTANCE To NEAREST WELL 6O It FOUNDATION Sa r It PROPERTY LINE O Q I 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 SUMPS�1 DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft WIDTH p1 ft LENGTH f ft DEPTH O ft / / DISTANCE TO NEAREST WELL 1:5'0 ft FOUNDATION ft PROPERTY LINE E3 0 ft ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEFrH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. MINIMUM SIGNED 46 HOUR ADVANCg NOTICE REQUIRED FOR INSPECT] N EASE CALL (209) 953-769 TITLE L _ DATE '% _/08_ Application Accepted By ' LXV L Final Inspection By�i1- Character of Sall to Depth of 3 COMMENTS (J I S n Cr IT- --L_6�j- -; DEPARTMENT USE ONLY �, r Date Area_C1 Employee ID#� Date 7- I I _ SPECIAL PERMIT - Approved by _ Pit/Sump Soil Character: AGI/?r('6' ,-/ 47tv ' q, -,r"- - � rC, e. j LI PE SC Received Check#/ Amount Date Permit/ Invoice # Permit ID# Code INFO Cash Remitted Service R uest # y )LI G, JIS 22CCL4300 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18 ;n