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ee_ <br />Employee ID# DA <br />C SPECIAL PERMIT -Approved by <br />Area <br />Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br />COMMENTS Poi n 1-'1,1 :010 Fetilt);E tsC her tT T . Ak, <br />pf( EIb f PC 0 <br />irs/ i-11)/1 <br />ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 42-01 <br />4/14/18 <br /> ANE <br />Recovvr et) AfAR 02 <br />8Algiv,‘ (34QU/hi c <br />21 <br />.RomuL„ouNry <br />---rti DE641ffityz-Nrittivr <br />Application Accepted B <br />Final Inspection By A alf <br />DEPARTMENT USE ONLY <br /> Date <br />Date 3/1 2-/207---/ <br />PE <br />Code <br />SC <br />INFO <br />Received <br />By <br />se) <br />Cash <br />Amount Amount <br />Remitted Date Permit/ <br />Service Request # Invoice # Permit ID# <br />//--- /70 ,24/7. *300 .2-2--i 5Q00g331-4t-t <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 />i 0 Wrimpe) Lane JOB ADDRESS 4 9 g <br />CROSS STREET 64/1” heAc . S APN % -?:0)S-0 1 q <br />PHONE <br />CITY/STATE/ZIP <br />- 509-7 <br />CITY/STATE/ZIP <br />LICENSE 0 )e-42 1C-36 OTHER NUMBER 45-90q5 <br />EXPIRATION DATE <br />WATER TABLE DEPTH: <br /> ft GEOGRAPHICAL INFORMATION: Coordinates X <br />crryizip '-e dl ) (A- <br />OWNER NAME b/000 Si-tue <br />OWNER ADDRESS <br />CONTRACTOR 6A1i7 ld 1/4 / <br />' <br />.se,pke . PHONE <br />CONTRACTOR ADDRESS 37 Y 4. 74ceo Alit br , 5.40c,640%., ott <br />PARCEL SIZE , <br />qd.6"-q31 • idl7 :SS311UCIV 31IS PERC TEST # BUILDING PERMIT # <br /> <br />LAND USE APPLICATION # <br />TYPE OF WORK: <br />NEW INSTALLATION <br />REPLACEMENT <br />N REPAIR/ADDITION <br />OUT-OF-SERVICE SEPTIC SYSTEM <br />I I ENGINEER DESIGNED /ALTERNATIVE <br />LI DESTRUCTION <br /> <br />INSTALLATION WILL SERVE: N RESIDENCE E COMMERCIAL ,•fer C OTHER <br /> <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: <br />Dolr; el <br />'V i e NUMBER OF EMPLOYEES: <br /> gal # OF COMPARTMENTS <br /> gal # OF COMPARTMENTS <br />ft PROPERTY LINE ft <br />TYPE OF PUMP 0 PKG TX PLANT 0 SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />31( LEACH LINES # OF LINES (2) LEACHING CHAMBERS LENGTH OF LINES 1/0 1 ft <br />. „,, - DISTANCE TO NEAREST WELL I U Li ' ft FOUNDATION ao ' ft PROPERTY LINE /0 i ft <br />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 y4) WIDTH 3 ' ft DEPTH 05 ' ft <br />DISTANCE TO NEAREST WELL /50 1 ft FOUNDATION 30 1 ft PROPERTY LINE JO ' 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 />DISTANCE TO NEAREST: WELL <br />LIFT STATION SIZE <br />SEPTIC TANK TYPE/MFG <br />GREASE TRAP TYPE/MFG <br />Cv.i.s4-; CAPACITY <br />CAPACITY <br />ft FOUNDATION <br />SIGNED <br />MINIMUM 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209)953-7697 <br />TITLE 6 '64 isf464e..- DATE 3 c? - (9,