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CONTRACTOR /"..<1.11 4 (j..:),->(-- • <br />CONTRACTOR ADDRESS /01112,1' IT)A%-). 12--•4 <br />APN 0/ PARCEL SIZE <br />PHONE .:2-62(;;; 6P/) • /2 71 <br />CITY/STATE/ZIP tiCi I ley Spiry< <75-0)S•c). <br />PHONE (9 /e5/4, <br />CITY/STATEIZiP C.:711V 'AT qc:S2/5-- <br />TYPE OF WORK: y..___ NEW INSTALLATION <br />REPLACEMENT <br />REPAIR/ADDITION <br />OUT-OF-SERVICE SEPTIC SYSTEM <br />ENGINEER DESIGNED /ALTERNATIVE <br />DESTRUCTION <br />0 OTHER <br />NUMBER OF EMPLOYEES: <br /> <br />INSTALLATION WILL SERVE: j‘..-RESIDENCE CommERc7. <br /> <br />NUMBER OF LNING UNITS: NUMBER OF BEDROOMS: <br />ft 3 ft OF LINES LENGTH OF LINES <br />ft PROPERTY LINE c 4 ft ft FOUNDATION .1/7 <br />ft <br />WIDTH <br />DISTANCE TO NEAREST WELL7'72 ft <br />CI FILTER BED WIDTH ft LENGTH <br />DISTANCE TO NEAREST WELL ft FOUNDATION <br />MOUNDED WIDTH ft LENGTH <br />DISTANCE TO NEAREST WELL ft FOUNDATION <br />SUMPS WIDTH ft LENGTH <br />DISTANCE TO NEAREST WELL ft FOUNDATION <br />DISPOSAL PONDS WIDTH ft LENGTH <br />DISTANCE TO NEAREST WELL <br />SEEPAGE PITS NUMBER <br />FOUNDATION /42 ft PROPERTY LINE <br />6 PE' <br />42-01 <br />4/14118 <br />ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <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 />CITY/ZIP <br />LICENSE CI C-42 D -C-36 OTHER <br />WATER TABLE DEPTH: <br />PERC TEST # <br />NUMBERe.42170,--5 EXPIRATION DATE /--7 <br />ft GEOGRAPHICAL INFORMATION: Coordinates X <br />BUILDING PERMIT # SP lqo 3776 LAND USE APPLICATION # <br />4 LEACH LINES LEACHING CHAMBERS <br />DISTANCE TO NEAREST WELL /L71) <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 />ft DEPTH ft <br />rt <br />FOUNDATION <br />Final Inspection By <br />87 <br />Date IV NZ ,Z) 0 SPECIAL PERMIT - Approved by <br />Character of Soil to Depth of 3 : 'i34) Pit/Sump Soil Character: <br />COMMENTS fJel"./ srg, fl W r 11 ic-* t>611 1. 3-13(n <br />DEPARTMENT1.17 ONLY <br />Application Accepted Date Area Li q c1 Employee IOU <br />PE <br />Code <br />SC <br />INFO <br />Received <br />By —Cash <br />Amount <br />Remitted Date Per nik/ <br />Service Request # , Invoice # Permit If* <br />oil //-2 zjiyd jy,sar) 4 S ?ii to .(to -20 Se 00 g7-2°11 <br />SEPTIC TANK <br /> <br />TYPE/MFG <br /> <br />CAPACITY gal # OF COMPARTMENTS <br />GREASE TRAP <br /> <br />TYPE/MFG CAPACITY gal ft OF COMPARTMENTS <br />DISTANCE TO NEAREST: WELL /Cie, '7) <br /> <br />ft FOUNDATION ie9 /7L <br /> <br />ft PROPERTY LINE <br />ft <br />CI LIFT STATION <br /> <br />SIZE TYPE OF PUMP <br /> <br />0 PKG TX PLANT <br /> <br />0 SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />JOB ADDRESS <br />CROSS STREET 777104/ <br />OWNER NAME// .fl 04/ <br />OVVNER ADDRESS o 60x 1-7 1.10 <br />NE4424a(MIRCV4Z <br />OSP4v TA4 <br />0:44, <br /> 0.4v4fEiv ikcei r <br />vei) Joy 6 <br />1)4