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CROSS STREET 5-1:47-a H /2-0 PARCEL SIZE Q. 42 A c, APN loo - /00- 23 <br />OWNER NAME 51-A Nt Eiv VA ND 012 VEF-Al <br />OWNER ADDRESS 5.! F I R5 -r- 571 <br />CONTRACTOR PROVO sr cn2 i TegAr2 coNsue.rfivei ria044e <br />CONTRACTOR ADDRESS 470,1 S,csc RD. <br />PHONE 4 7/-76 /; <br />CiryISTATErzip CA 95 3 za <br />PHONE 2.-ef —4a 2 -1‘ S.. 2. <br />crryisTATErze ft7cpc7a , <br />NUMBER C7547, EXPIRATION DATE LICENSE QC-42 QC-36 OTHER 264' <br />GEOGRAPHICAL INFORMATION: Coordinates X So 2.! It WATER TABLE DEPTH: <br />NEW INSTALLATION <br />REPLACEMENT <br />TYPE OF WORK: <br />PERC TEST # <br /> BUILDING PERMIT # LAND USE APPLICATION # <br />REPAIR1ADDMON <br /> O ENGINEER DESIGNED !ALTERNATIVE <br />OUT-OF-SERVICE SEPTIC SYSTEM <br /> O DESTRUCTION <br />ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET - STOCKTON CA 95202- (209) 468-3420 <br />NON-REFUNDABLE PERMIT CALL (209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />JOB ADDRESS 1 7 goo Spun/ cam,- giug x gt,. CITYrZIP n/Trc A I cl <br />INSTALLATION WILL SERVE: D RESIDENCE re COMMERCIAL <br />NUMBER OF LIVING UNITS: <br />0 OTHER <br />NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br />-14-frryx, SIGNED TITLE R. e•E DATE <br />A <br />Alp WEL <br />AG <br />PAYM ENT <br />RECEIVED <br /> jut4 2.5 IC <br />01,8)th 4 <br />EN\ 1130/4,0-41, <br />-; <br />Liii ow() <br />R.L.A/Axp <br />Peo-z, <br />SEPTIC TANK <br /> <br />TYPE/MFG CAPACITY gal # OF COMPARTMENTS <br />GREASE TRAP <br /> <br />TYPE/MFG CAPACITY gal # OF COMPARTMENTS <br />DISTANCE TO NEAREST: WELL <br /> ft FOUNDATION ft PROPERTY LINE ft <br />LIFT STATION <br /> <br />SIZE TYPE OF PUMP <br /> PKG TX PLANT <br /> SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />CI LEACH LINES 0 LEACHING CHAMBERS <br /> <br /># OF LINES LENGTH OF LINES It <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />FILTER BED WIDTH ft LENGTH <br /> ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />MOUNDED WIDTH <br /> ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL <br /> ft FOUNDATION ft PROPERTY LINE ft <br />CI SUMPS WIDTH <br /> ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL <br /> <br />ft FOUNDATION ft PROPERTY LINE ft <br />CI DISPOSAL PONDS WIDTH <br /> ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL <br /> ft FOUNDATION It PROPERTY LINE ft <br />CI SEEPAGE PITS NUMBER WiDTH ft DEPTH It <br />DISTANCE TO NEAREST wELL <br /> ft FOUNDATION ft PROPERTY 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 />STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br />MI M 24 ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209)953-7697 <br />pti <br />DEPARTMENT U(SE ONLY <br />Area Date c2-- Employee 10# <br />.-"?" Date &MY/ 2— 0 SPECIAL PERMIT - Approved by 44. • Par <br />Character of Soil to De th of 3 Ft: Pit/Sump Soil Character <br />COMMENTSAti4V-eid/-e-l_' 65.. le )-(r tee, (r32 476f74,„1.,) gC7/r 1)/i5gar3 <br />Application Accep <br />Final Inspection By <br />4414 C-375 <br />PE <br />Code <br />SC <br />INFO <br />Received i:!Ilscl#N---." <br />Cash <br />Amount <br />Remitted Date Permit/ <br />Service Request # Invoice # Permit IDif <br />&F-1-7-z- 5" 2, ( <br />(72_ <br />ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 42-01 <br />9/21/10