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WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # NON-REFUNDABLE PERMIT CALL (209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED CONTRACTOR Wekt 0.4q2S+ 1;aC4 -hot' PHONE 2-0 • 3 '7- LP 3c14 CONTRACTOR ADDRESS iiita,VI•ve II S-f-• CrrreSTATEJZIE 1-044.4.1 Cict 4512-40 LICENSE 1 1 C-42 Li C.36 OTHER A NUMBER R51151 EXPIRATION DATE 7 b JOB ADDRESS CROSS STREET OWNER NAME irm ks on OWNER ADDRESS San(1. AS Above, CFTVZII APN lece.0J0c)- PARCEL SIZE -P S PHONE 2,0q. (02-61 • 209 CITY IS TATE/ZIP 24-110 Lot-thiry le-cL S. PLEASE CALL (209)953 7697 DATE V2L.tl.k) ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JoACtuiN CO iNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE- STOCKTON CA 95205- (209) 468-3420 TYPE OF WORK: NEW INSTALLATION , REPLACEMENT I I: REPARBADDIT1ON OUT-OF-SERVICE SEPTIC SYSTEM ENGINEER DESIGNED /ALTERNATIVE DESTRUCTION INSTALLATION WILL SERVE: T! RESIDENCE G COMMERCIAL NUMBER OF LMNG UNITS: NUMBER OF BEDROOMS: E OTHER NUMBER OF EMPLOYEES: ci SEPTIC TANK Ty FE/MF -irovkz CAPACITY gal # OF COMPARTMENTS 0 GREASE TRAP TypE/Mrc CAPACITY gal # OF COMPARTMENTS DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE S ft 0 LIFT STATION SIZE TYPE TYPE OF PUMP O PKG TX PLANT 0 SAND OIL SEPARATOR (ENCLOSED SYSTEM) LEACH UNES LEACHING CHAMBERS - LENGTH OF LINES ft 0 # OF LINES DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft 12 FILTER BED WIDTH 2-5 ft LENGTH 7_ 9 ft DEPTH ft DISTANCE TO NEAREST WELL 5c) ft FOUNDATION ICI t ft PROPERTY LINE St• ft MOUNDED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PHOPEN I Y LINE ft 0 SUMPS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft 0 DISPOSAL PONDS WiDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft SEEPAGE PITS NUMBER WIDTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. a • MINIMUM 48 OUR ADVANC NOTICE REQUIRED FOR INSPECTION - .. SIGNED -2 TITLE (1 S4 ) DEPARTMENT USETNLY Date •• Area Employee !Ott Application Accepted By Final Inspection By Data II AI 202,1 SPECIAL PERMIT - Approved by Character of Soil to Depth of 3 Ft: litttSump Soil Character: COMMENTS r, ; r, f sy$-tervi • E X )51-615 „ PE Code SC Iwo Received By Chech#1 Cash , Amount Remitted Date Permit/ Service Request * Invoice # Permit ID# -/-3 )0 12-14.),LcpNaos-r1 42-01 /18)-7 ONSITE WASTEWATER TRTmNT SYSTEM PERMIT 4/14/18 LiX