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<br />R PAIR/ADDITION <br />ENGINEER DESIGNED /ALTERNATIVE <br />NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br />) 0( T-OF-SERVICE SEPTIC SYSTEM <br /> <br />COMMERCIAL ft.fl9 IJ OTHER <br />DESTRUCTION <br />PERC TEST <br />TYPE OF WORK: NEW INSTALLATION <br />REPLACEMENT <br /> <br />INSTALLATION WILL SERVE: D RESIDENCE <br /> <br />NUMBER OF LIVING UNITS: <br />4.1 <br />\ <br />42-G1 <br />4/24/12 <br />ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />: <br />\tv <br />sht f <br />86,m <br />t Co tzr, Pq 11 ,2A <br />I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br />STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br />MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209)953-7697 <br />SIGNED &AM* TITLE CVtLrifINCIDC DATE a <br />Area 4q <br />D SPECIAL P R MIT - Approved by <br />t/Sump Soil Character: <br />N L Y <br />Application Accepted <br />COMMENTS <br />Final Inspection By <br />Character of Soil to Deyof 3 Ft: <br />DEPARTME <br />Date <br />Date <br />i ARS Eniploya,1 ID <br />PE <br />Code <br />SC <br />INFO <br />Received <br />By <br />Check*/ <br />Cash <br />Amount <br />Remitted Date ,ermit/ <br />Service Request # Invoice # Permit D# I <br />421(9 LICA 71.4 -7 C57,1 1-2-C sfL. co 7— 73; Ci <br />Illihal IcPil k1(2 7 I11,71 <br />ONSITE WASTEWATER TREATMENT SYSTEM PERMIT •fte,// <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE- STOCKTON CA 95205- (209) 468-3420 <br />NON-REFUNDABLE PERMIT CALL 209) 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />JOB ADDRESS I'lg 00 S (cam (OCO NY,.< 1:? crrazip till7 -,(1i q5 <br />ApNZ-6q ,-/ill•--0 PARCEL SIZE <br />OWNER NAME A Ml-C,(kN Crrxrv , W&A,, gc."-77-y il De/464e <br />OWNER ADDRESS ilifsr _ii CITY/STATE/ZIP • g. A Ai ag A Ai l,-S Zo - <br /> <br />CROSS STREET 44.Y La <br />CONTRACTOR So CU N.C(-473Sc ic PHONE <br />CONTRACTOR ADDRESS "-S- / 9 1:Q.ci fvte. Cm/STATE/ZIP urt-oc, <br />LICENSE 17 0-42 U C-36 OTHER NUMBER '73 rbi I EXPIRATION DATE \c-",1,2 - <br />WATER TABLE DEPTH: N1S. GEOGRAPHICAL INFO AT ON: Coordinates X <br />TYPE/MFG P. <br />CAPACITY ia 0 <br />TyPEBVIEG CAPACITY <br />DISTANCE TO NEAREST: WELL 4"Z" • ft FOUNDATIO <br />SIZE TYPE OF PUMP PKG TX PLANT <br />• <br />gal V OF COMPARTMENTS 2 <br />gal V OF COMPARTMENTS <br />ft PROPERTY LINE •;4.3 <br />0 SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />g ft <br /># OF LINES LENGTH OF LINES ft <br />It PROPERTY LINE ft <br />ft DEPTH ft <br /> ft PROPERTY LINE /4) I ft <br /> ft DEPTH ft <br /> <br />ft FOUNDATION ft PROPERTY LINE ft <br /> ft DEPTH ft <br /> ft FOUNDATION ft PROPERTY LINE ft <br />ft DEPTH ft <br /> <br />ft FOUNDATION ft PROPERTY LINE It <br />WIDTH ft DEPTH ft <br /> ft FOUNDATION ft PROPERTY LINE <br />ft <br />FILTER BED lb° <br />DISTANCE TO NEAREST <br />MOUNDED WIDTH <br />DISTANCE TO NEAREST <br />SUMPS WIDTH <br />DISTANCE TO NEAREST <br />DISPOSAL PONDS WIDTH <br />SEPTIC TANK <br />GREASE TRAP <br />LIFT STATION <br />LEACH LINES <br />IDTH <br />i <br />LEACHING CHAMBERS <br />5iSiANCE TO3EAREST WELL VNDATION <br />ft LENGTH 1;t: <br />WELLpt,6410. V?OUNDATION <br />ft LENGTH <br />WELL <br /> 11 LENGTH <br />WELL <br /> ft LENGTH <br />DISTANCE TO NEAREST WELL <br />SEEPAGE PITS NUMBER <br />DISTANCE TO AEAREST WELL