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NON-REFUNDABLE PERMIT <br />3 3 <br />04.2 1..ig09) 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />JOB ADDRESS Crry/Zip <br />APN 0 10 306 PARCEL SIZE 1,10 <br />cirasTATEIzip St-ock+JY1 9 Sal - <br />PHONE (7, '/) 4.1 J71- 4/11-3 <br />CITY/STATE/ZIP 664 <br />EXPIRATION DATE ///2/de.°7 1' <br />CROSS STREET 4Ei-7 <br />OWNER NAME eri 7) Orr ine <br />OWNER ADDRESS q a Le14 Yid <br />CONTRACTOR <br />11) olv <br />ey <br />tz. <br />PHONE <br />CONTRACTOR CONTRACTOR ADDRESS / fotiv:•.f..,o „, <br />LICENSE DOC-42 D =C-36 OTHER A. NUMBER )/ )7/17 <br />WATER TABLE DEPTH: <br />fl PERC TEST # <br />ft GEOGRAPHICAL INFORMATION: Coordinates X <br />BUILDING PERMIT # <br /> <br />LAND USE APPLICATION # <br />TYPE OF WORK: IL NEW INSTALLATION REPAIR/ADDITION C ENGINEER DESIGNED /ALTERNATIVE <br />0 REPLACEMENT L OUT-OF-SERVICE SEPTIC SYSTEM 0 DESTRUCTION <br /> <br />INSTALLATION WILL SERVE: O RESIDENCE 0 COMMERCIAL <br />0 OTHER <br /> <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br />CI SEPTIC TANK TYPE/MFG CAPACITY gal # OF COMPARTMENTS <br />CI GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS <br />DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br />0 LIFT STATION SIZE TYPE OF PUMP 0 PKG TX PLANT 0 SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />1 0 LEACH LINES E, LEACHING CHAMBERS ,/ ).2 .6 # OF LINES LENGTH OF LINES Gre ft <br />DISTANCE TO NEAREST WELL "4".-' ft FOUNDATION —2 0 ft PROPERTY LINE 2.-^' ft <br />0 FILTER BED WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />CI MOUNDED WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />CI SUMPS WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY UNE ft <br />DI DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY UNE ft ----, <br />El SEEPAGE PITS NUMBER 2 WIDTH ft <br />/31^ <br /> _..) ft DEPTH -z. 1-- <br />WELL DISTANCE TO NEAREST ft FOUNDATION .?CL - ft PROPERTY UNE ..."1::5 ' 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 />MINIMUM 4 OUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209)953-7697 <br />SIGNED <br />TITLE DATE — <br />( 3L1S ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 -(209) 468-3420 <br />'Es <br />ety <br />DEPARTMEN U$E ONLY <br />Application Accepted A, <br />Final Inspection By , <br />Date "3 /ci 'I/ il I Area 1 /(: CI <br />Date 31i izt 0 SPECIAL PERMIT - Approved by <br />Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br />COMMENTS clinc csys4Phi. EXiS}-1/16 lineS ft) lerrreqrrl • 1y -lc . No vsiells <br />1/4 ) Thin getb4ks per 0-1b re corGIS- <br />PE <br />Code <br />SC <br />INFO <br />Received Check Amount Date i <br />Permit/ <br />Service Request # Invoice # Permit ID# By ash Remitted _ <br />9 a19 11 s-- 1416 Hq8 °0 3 2 /84 <br />471 <br />6 SP.00g13,27 <br />3 <br />E AQL, 1111 /4i, N <br />8414Th htVilf,°_411Vry —4.-metri pt <br />Employee ID# 'wEAT <br /> ou-wi <br />2021 <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4/14/18