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tJ N11. YR, en- won- _ vft. 6 2021 coo , ktov..7,444?), OgrrEP 14,47. Employee ID# DA r\- \IT-1\1 DEPARTMENT US F ONLY Date ..)/14.1or Area qi C; ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 -(209) 468-3420 NON-REFUNDABLE PERMIT CALL (209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED Joe ADDRESS /96 2 5 .a. Sod 7//4)O4///a 4 o c.a.. cti/i-ez C 2, 95' Z y- CROSS STREET CPO FS 7e, .021). 4 0 APN 023 - 2-60-0 3 p,....s. 3w OWNER NAME 505941 34 lc, 6 hi PHONE 2oci-Isto-2.5 70 OWNER ADDRESS 913 g L5cdedz 751/ Coo kr CITY/STATE/ZIP c;',/e.r A q. 232.. CONTRACTOR E...) Ain /600 12? 4 dr:, / t /01) CONTRACTOR ADDRESS Pe 6t9 X 3 LICENSE H C 4 -42 E C-36 OTHER ,11 e'd I NUMBER 14/756P, EXPIRATION DATE PHONE 20 9 3 2 9 s / crryisTATEizip 6 t )1 CV. 9521-' o7- zaL( WATER TABLE DEPTH: PERC TEST # TYPE OF WORK: NEVI INSTALLATION REPLACEMENT ft GEOGRAPHICAL INFORMATION: Coordinates X BUILDING PERMIT # LAND USE APPLICATION # REPAIR/ADDITION ENGINEER DESIGNED /ALTERNATIVE OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION lef-prear.-4, e INSTALLATION WILL SERVE: "r61 RESIDENCE El COMMERCIAL Ii OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: gal # OF COMPARTMENTS gal # OF COMPARTMENTS ft PROPERTY LINE ft U SAND OIL SEPARATOR (ENCLOSED SYSTEM) SEPTIC TANK TYPE/MFG CAPACITY GREASE TRAP TYPE/MFG CAPACITY DISTANCE TO NEAREST: WELL ft FOUNDATION LIFT STATION SIZE TYPE OF PUMP PKG TX PLANT LEACH LINES LEACHING CHAMBERS # OF LINES LENGTH OF LINES ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft FILTER BED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft MOUNDED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft CI SUMPS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft DISPOSAL PONDS WIDTH ft LENGTH DISTANCE TO NEAREST WELL SEEPAGE PITS NUMBER WIDTH DISTANCE TO NEAREST WELL ft DEPTH ft ft FOUNDATION ft PROPERTY LINE ft ft DEPTH ft ft FOUNDATION ft PROPERTY LINE ft I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLJCATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. S GNED e -/-k- mu CON fte crio 4_ DATE MINIMU 8 NCE NOTICE REQUIRED F - PLEASE / 0R INSPECTIONS_ CALL (209)953-7697 '2121-4 Application Accepted By Final Inspection By ‘Tct skcS Date 112 (i i LI SPECIAL PERMIT - Approved by Pit/Sump Soil Character: COMMENTS (Q__ c if j or,ii..lhfol. 0 sepi ie k . LA400,4)1 cfl- 1-1n1P per Pa I i )t 'c1. Character of Soil to Depth of 3 Ft: PE Code SC INFO Received I Check#/ -- Amount Remitted Date sqCash Permit/ Service Ruest X Invoice # Permit ID# 0 7 S. B4."-V Ot i S- 2/1(/ /7 ,1 ' f() 03agS- 42-01 4/14/18 1109-2_o_z-9- ONSITE WASTEWATER TRTMNT SYSTEM PERMIT