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PERC TEST # TYPE OF OF WORK:„..--NEW INSTALLATION Li REPAIRADDMON Ii REPLACEMENT t-ttlA k Cl OUT-OF-SERVICE SEPTIC SYSTEM BUILDING PERMIT # LAND USE APPLICATION # I] NGINEER DESIGNED /ALTERNATIVE DESTRUCTION -frio 4-4.P 6:41V 711 4%11C4 410 4pa,,(71;/ IV en, 66vz.4f,tEiVq17 )' 4,f8iv 14, /3 4.Cerf4t J at!) I 7 ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAzELroN AVENUE - STOCKTON CA 95205 -(209) 468-3420 NON-REFUNDABLE PERMIT CALL (209) 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED :SSMICHIV 3.LIS JOB ADDRESS 551, (i9 hes rA,i in ciTymp 11/1 /14114-,c-gr1- edf- cie-4--.3 3 j CROSS STREET 41e1 tzAl-r-1-5e-- APN iq 7 o 8.036 PARCEL SIZE f ELL,of OWNER NAME PHONE OWNER ADDRESS .s;r4 ify? e CITY/STATE/ZIP CONTRACTOR OP' • 11442S .6 e?..-4( 4 .3-4....saT, PHONE 456 —. ,g— CONTRACTOR ADDRESS p e,-,x, 6 tro c IT Y 1 ST ATE/ZIP kaa4e444. f4- 9 LICENSE oLic-42 o DC-36 OTHER /4 NUMBER (Itorgcr-Sli EXPIRATION DATE WATER TABLE DEPTH: do -30 ft GEOGRAPHICAL INFORMATION: Coordinates X INSTALLATION WILL SERVE: cyliESIDENCE E COMMERCIAL Pt Fori-4 E OTHER NUMBER OF LIVING UNITS: I NUMBER OF BEDROOMS: t c'0 NUMBER OF EMPLOYEES: IV-B-EPTIC TANK TYPE/MFG e4- 1-- CAPACITY arr0 gal # OF COMPARTMENTS a 0 GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS I DISTANCE TO NEAREST: WELL i 6i, I ft FOUNDATION i o 1 ft PROPERTY LINE it,a ft L3 LIFT STATION SIZE TYPE OF PUMP 0 PKG TX PLANT 0 SAND OIL SEPARATOR (ENCLOSED SYSTEM) W<EACH LINES _ LEACHING CHAMBERS # oF LINES 3 LENGTH OF LINES -7_g.- / ft DISTANCE TO NEAREST WELL 001 ft FOUNDATION (01 ft PROPERTY LINE KS . ft I] FILTER BED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ID MOUNDED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft V./SI/IMPS WIDTH f?1 ft LENGTH ta ' ft DEPTH 61 ft DISTANCE TO NEAREST WELL t—Scil ft FOUNDATION 10 ft PROPERTY LINE (t‘ 1 ft U DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft LI SEEPAGE PITS NUMBER WIDTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE 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. MINIMUM 48 HOUR ADVA E-NOTTCE REQUIRED FOR INSPECTIONS - PLEASE CALL 209 953-7697 TITLE C-cp1 re.e.3..- 4- DATE I L3 .9-I ft DEPARTMENT USE ONLY Application Accepted By ---,----”— ------Z-Z____' -- Date iii-3/10120 Area 3 /q q Employee ID# Final Inspection By -/- , Cs)-----____---------- Date 1 2 \ 7 0 SPECIAL PERMIT - Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: 5 e /12"IGL A COMMENTS ReCt Z.?)1 or rep it;:t_ Prier; r opi-ir • "r;er i1 . c, pQ E1b yeco-rdS. PE Code SC INFO Received By / Check#/ Cash Amount Remitted Date Permit/ Service Request # Invoice # Permit ID# 9R10 11S- QIIA?) VOIDS .: OD I-13 -1 300 kS 151 SIGNED ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 42-01 4/14/18