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NON-REFUNDABLE PERMIT CALL (209) 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />40 la Tit I sq ortfe Ave- <br />6-010fr-opoi, s <br />Cheoi. Lor - <br />CITY/ZIP _...51:Ce-k* 74%ij <br />APN 10.31 1 DI L1 <br />PHONE go - (0 9'8/ <br />JOB ADDRESS <br />CROSS STREET <br />OWNER NAME <br />PARCEL SIZE / <br />NUMBER 11-6-9114/ 5.- EXPIRATION DATE LICENSE Er-42 El LIC-36 OTHER <br />0 PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # <br />NEW INSTALLATION <br />REPLACEMENT <br />TYPE OF WORK: H ENGINEER DESIGNED /ALTERNATIVE REPAIR/ADDITION <br />I OUT-OF-SERVICE SEPTIC SYSTEM [I DESTRUCTION <br /> <br />INSTALLATION WILL SERVE: RESIDENCE <br /> <br />NUMBER OF LIVING UNITS: <br />COMMERCIAL <br />NUMBER OF BEDROOMS: <br />E OTHER <br />NUMBER OF EMPLOYEES: <br />TITLE /111/k4 DATE 3 / GNED SI <br />Application Accepted <br />Final Inspection By <br />ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 -(209) 468-3420 <br />WATER TABLE DEPTH: -20 - ft GEOGRAPHICAL INFORMATION: Coordinates X :ssalluaV allS SEPTIC TANK TYPE/MFG 6b.-541 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 />LIFT STATION SIZE TYPE OF PUMP U PKG TX PLANT U SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />0 FILTER BED WIDTH ft LENGTH <br />DISTANCE TO NEAREST WELL ft FOUNDATION <br />CI MOUNDED WIDTH ft LENGTH <br />DISTANCE TO NEAREST WELL ft FOUNDATION <br />CI SLMPS WIDTH ft LENGTH <br />DISTANCE TO NEAREST WELL ft FOUNDATION <br />CI DISPOSAL PONDS WIDTH ft LENGTH <br />DISTANCE TO NEAREST WELL ft FOUNDATION <br />X SEEPAGE PITS NUMBER (II ) WIDTH 3(0 <br />Ii <br />DISTANCE TO NEAREST WELL Pio / ft FOUNDATION <br />4 <br />4ritr <br />01411,v <br />(Pt <br />fr p; <br />i <br />rte 11:3- <br /> 11) <br />Cy, e-ps ("4 <br />)442eLei <br />New <br />3C5.6H <br />X LEACH LINES • I LEACHING CHAMBERS # OF LINES (2) LENGTH OF LiNEs q 0 1 ft <br />(70 <br />/ <br />ft FOUNDATION 3o ' ft PROPERTY LINE WI do' ft DISTANCE TO NEAREST WELL <br />Employee ID# <br />Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br />COMMENTS RI Ir. " sys-tem 5Y5-1 err eA7,s )-31-- <br />12_6 <br />A 6 12-62-1 SPECIAL PERMIT -Approved by <br />DEPARTMEN U/SE ONLY <br />Date -? <br />1" <br />i //, 1 Area <br />Date <br /> MMENT <br />RECEIVED <br />MAR 1 1 2021 <br />SAN JOAQUIN-COUNTY <br />ENVIRONMENTAL <br />.-ru- I ucrAK I MEI <br />PE <br />Code <br />SC <br />INFO <br />Received Check#/ <br />Cash Date l / i <br />Amount <br />Remitted <br />Permit/ <br />Service Request # Invoice # Permit ID# <br />L-010 us- /13Y/2../. -. +30D 3 11-21 1200,ZS301 I-- <br />ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 42-01 <br />4/14/18 <br />ft DEPTH ft <br />ft PROPERTY LINE ft <br />ft DEPTH ft <br />ft PROPERTY LINE ft <br />ft DEPTH ft <br />ft PROPERTY LINE ft <br />ft DEPTH ft <br />ft PROPERTY LINE ft <br />DEPTH a 5-1 ft <br />80 i ft PROPERTY LINE /0 / ft <br />&4 <br />6,0 41), q 1/41 I et) crip h <br />7 Ce qrfe.'pi <br />CITY/STATE/ZIP <br />PHONE 020 36,7-5-0,P7 <br />cingsTATEIzip )49 tie (.4 9S7:2,/ 9 Ake p CONTRACTOR ADDRESS <br />OWNER ADDRESS <br />CONTRACTOR