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PHONE CONTRACTOR AAA gockhof <br />CITY/STATE/ZIP in fieSYTDI (11— CONTRACTOR ADDRESS Z 12S— wykrofr i5fe <br />NUMBER EXPIRATION DATE LICENSE DEC-42 El 0 C-36 OTHER <br />WATER TABLE DEPTH: <br />E PERC TEST # <br />ft GEOGRAPHICAL INFORMATION: Coordinates X <br />BUILDING PERMIT # LAND USE APPLICATION # <br />I I ENGINEER DESIGN5../ALTEITATIE <br />l - OUT-OF-SERVICE SEPTIC SYSTEM a DESTRUCTION a/A C- I <br />REPAIR/ADDiTioN <br />INSTALLATION WILL SERVE: 'XI RESIDENCE <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: <br />E COMMERCIAL OTHER <br />NUMBER OF EMPLOYEES: 2_ <br />,16 SEPTIC TANK TYPE/MFG Conc. rt-I-c CAPACITY /co gal # OF COMPARTMENTS 2- <br />E NEW INSTALLATION <br />A REPLACEMENT 1;4 <br />TYPE OF WORK: <br />ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <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 1 A- I I CITY/ZIP , je C a Akt <br />OWNER NAME 9 APN I 9 I Z O 6 3 PARCEL SIZE <br />PHONE <br />,3 CROSS STREET 5 mei n <br />OWNER ADDRESS CITY/STATE/ZIP <br />(02* <br />TITLE re mail DATE / — eb a ( <br />PARTMENT USE ONLY <br />Application Accepted By air it Date Area 1 ( Employee ID# <br />eia <br />4,214)111/4WP4r <br />Final Inspection By A r , g 1 0, Date (1 7._C, 12 \ a SPECIAL PERMIT -Approved/ <br />' Character of Soil to Depth of 3 Ft: Pit/Sur Soil raracter:r <br />r -0,/ ck) ri (_:e P 6 IAA/149 COMMENTS <br />k?‘ <br />GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS <br />DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br />El LIFT STATION SIZE TYPE OF PUMP 0 PKG TX PLANT 0 SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />CI LEACH LINES E LEACHING CHAMBERS # OF LINES LENGTH OF LINES ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />El FILTER BED WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />MOUNDED WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />SUMPS WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL 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 /> <br />DVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL 209 953-7697 MINIM 48 <br /> <br />PE <br />Code <br />SC <br />INFO <br />Received <br />By <br />Check#/ <br />cash <br />Amount <br />Remitted Date Permit/ <br />Service Request # <br />- vy j <br />Invoice.# evil <br />ntt. <br />"*. V4/ <br />Quip/mit lin <br />L2 R2 I i 5a07-(11/1514 ?oV 1-13-21 51z002.311-1 0/V4/ cOlhv oe„sizi 7-1, <br />, me•Aq. <br />42-01 <br />4/14/18 1(120(21ag—i ONSITE WASTEWATER TRTMNT SYSTEM PERMIT