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JOB ADDRESS .2/6 44 5. Coi2J2A /ZD ciTyizip TPAcy 9'5304 <br />CROSS STREET <br /> <br />01/fR. APN /90 62,•2 <br /> <br />PARCEL SIZE C2 . <br />OWNER NAME Nit ssig 41,41<moup A/ALEN1-4 ki REfil/A PHONE 409 .;36 - ?I/ <br />OWNER ADDRESS r2 3 (..c2 7 /4414.5E/4 tzt) • <br /> <br />CITY/STATE/ZIP 777—A, C-y cA 9s 304 <br />CONTRACTOR Cfl t-/ Cr._)/J-SIA C-7 -//\/(-7 <br />PHONE <br />CONTRACTOR ADDRESS P. o .B'- 37 4 <br />CITY/STATE/ZIP —Ft< 21-0 r CA 9 51? (2> ( <br />LICENSE 0 I IC-42 CI' IC-36 OTHER Rie_ NUMBER C75411 EXPIRATION DATE 6 /3 /2 fo <br />PERC TEST # BUILDING PERMIT # <br /> <br />LAND USE APPLICATION # <br />DISTANCE TO NEAREST WELL <br />WIDTH <br /> <br />ft LENGTH <br />DISTANCE TO NEAREST WELL <br />WIDTH ft LENGTH <br />ft FOUNDATION ft PROPERTY LINE ft <br /> ft DEPTH ft <br />ft FOUNDATION ft PROPERTY LINE ft <br />ft DEPTH ft <br />MOUNDED <br />SUMPS <br />0 <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 />WA/TER TABLE DEPTH: <br /> •-‘,/0 ft <br />GEOGRAPHICAL INFORMATION: Coordinates X <br />TYPE OF WORK: I 1 <br /> <br />NEW INSTALLATION REPAIR/ADDITION Li ENGINEER DESIGNED /ALTERNATIVE <br />REPLACEMENT <br /> <br />OUT-OF-SERVICE SEPTIC SYSTEM P DESTRUCTION <br /> <br />INSTALLATION WILL SERVE: E RESIDENCE <br /> <br />0 COMMERCIAL <br /> <br />OTHER <br /> <br />NUMBER OF LIVING UNITS: <br /> NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: :SS311(IGV 31IS SEPTIC TANK <br />GREASE TRAP <br />TYPE/MFG <br />TYPE/MFG <br />DISTANCE TO NEAREST: WELL <br /> CAPACITY gal # OF COMPARTMENTS <br /> CAPACITY gal # OF COMPARTMENTS <br />ft FOUNDATION ft PROPERTY LINE <br /> <br />ft <br />LIFT STATION SIZE TYPE OF PUMP U PKG TX PLANT CI SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />FILTER BED WIDTH ft LENGTH <br /> # OF LINES LENGTH OF LINES ft <br />FOUNDATION ft PROPERTY LINE ft <br /> ft DEPTH ft <br />LEACH LINES H LEACHING CHAMBERS <br />DISTANCE TO NEAREST WELL ft <br />DISTANCE TO NEAREST WELL <br /> <br />ft FOUNDATION ft PROPERTY LINE ft <br />DISPOSAL PONDS WIDTH ft LENGTH <br />DISTANCE TO NEAREST WELL <br />LI SEEPAGE PITS NUMBER <br /> ft DEPTH ft <br />ft FOUNDATION ft PROPERTY LINE ft <br />WIDTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION <br /> <br />ft PROPERTY LINE <br /> <br />ft <br />I HEREBY CERTIFY HAT 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 />MIN /UM 48 H • U ) • DVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209)953-7697 <br />SIGNED TITLE eithi- i,6Ej2 DATE/ <br />PAYME T <br />0 <br /> <br />RECEIVED <br />;e. <br />Pkakic.- -r Dc.0 1 8 2120 <br />-J <br />SAN JOAQUIN <br />EINVIRONME <br />gorn EALTH DE PA RTME NT <br />fo <br />g_ <br />Application Accepted By Date /3/49p Area Siefq DEPARTMENT USf ONLY <br /> Pit/Su <br />t <br />p Soil Character: <br /> <br />\-2t <br />E SPECIAL PERMIT - Approved by <br />Employee ID# <br />PE <br />Code <br />SC <br />INFO <br />Received <br />B <br />Check#/ <br />Cash <br />Amount <br />Remitted Date Permit/ <br />Service Request # Invoice # Permit ID# <br />l'Idg?0 C '--& <br />iii. <br />(II -/' 4 / s- 12128 74)k 00t3DgS <br />42-01 <br />ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />COUN <br />WEAL <br />TY <br />Final Inspection By <br />Character of Soil to Depth of 3 Ft: <br />COMMENTS <br />Date <br />4/14/18