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PERC TEST # TYPE OF WORK: NEW INSTALLATION REPLACEMENT LI INSTALLATION WILL SERVE: TESIDENCE NUMBER OF LIVING UNITS: MINIMUM 48 SIGNED Area /11 Employee ID# Date Date DEPARTMENT N L Y 42-01 4/14/18 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT Application Accepted By Final Inspection By la , Character of Soil to Depth of 3 Ft: COMMENTS.dieZ9 , Tier 2 Neat &0//iM je."64Cia" fir- es-Ho ree,roec. it/Su p Soil Character: PE Code SC INFO Received Check#/ ca,sh , Amount __Remitted Date Permit/ Service R epwe Invoice # Permit ID# l-ld I D 11S- B ( I /V It 4.1 f3o 't) I fr1/1-1 5# spoo$ 0 SPECIAL PERMIT - Approved by ILL 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)03-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS CROSS STREET OWNER NAME OWNER ADDRESS tr21.19 L. CONTRACTOR On 1/44-4.:15 Ar N -at) -4/9 444 keelfdt_ 77: — PHONE PARCEL SIZE :S5111(111)/ 3,LIS pci€ C.Piekvart eatery(7ay, CITY/STATE/ZIP PHONE Li NV, CONTRACTOR ADDRESS pa /61-N,X to. s-0 CITY/STATE/ZIP Iftle.t/Nerod )44- LICENSE 07C-42 0=C-36 OTHER /4_ NUMBER 6,10 EXPIRATION DATE WATER TABLE DEPTH: — t) ft GEOGRAPHICAL INFORMATION: Coordinates X COMMERCIAL 1 OTHER NUMBER OF BEDROOMS: -1 Pc. iGe ) NUMBER OF EMPLOYEES: NI -j Or gal # OF COMPARTMENTS CAPACITY CAPACITY gal # OF COMPARTMENTS ft FOUNDATION ft PROPERTY LINE ft PKG TX PLANT 0 SAND OIL SEPARATOR (ENCLOSED SYSTEM) BUILDING PERMIT # LAND USE APPLICATION # oLe.172EPAIRIADDMON u ENGINEER DESIGNED /ALTERNATIVE L; OUT-OF-SERVICE SEPTIC SYSTEM u DESTRUCTION SEPTIC TANK TYPE/MFG GREASE TRAP TYPE/MFG DISTANCE TO NEAREST: WELL LIFT STATION SIZE TYPE OF PUMP LEACH LINES C LEACHING CHAMBERS # OF LINES DISTANCE TO NEAREST WELL ft FOUNDATION Le) I 1=7"t DISTANCE TO NEAREST WELL ft FOUNDATION 1'. MOUNDED WIDTH ft LENGTH DISTANCE TO NEAREST WELL ft FOUNDATION 10FILTER BED WIDTH ft LENGTH ft ig LENGTH OF LINES ft ft PROPERTY LINE ft DEPTH 1 S I ft ft PROPERTY LINE k 01 ft ft DEPTH ft ft PROPERTY LINE ft SUMPS WIDTH ft LENGTH DISTANCE TO NEAREST WELL ft FOUNDATION DISPOSAL PONDS WIDTH ft LENGTH ft DISTANCE TO NEAREST WELL ft FOUNDATION SEEPAGE PITS NUMBER WIDTH DISTANCE TO NEAREST WELL ft FOUNDATION ft DEPTH ft ft PROPERTY LINE ft DEPTH ft ft PROPERTY LINE ft ft DEPTH ft 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. / ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953 697 TITLE CL•r)/1 pp,4,..A, 5" DATE 1/ )// ,..)47 Ae_ PAYMENT RECEIVED JAN 2 1 2021 JOAQUIN COUNTY ENVIRONMENTAL EALTH DEPARTMENT