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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 />9 <br />JOB ADDRESS ice n ,. ot . cinizip .I- , , 4.. --i" <br />CROSS STREET A ' I"', <br /> r <br /> APN ...Of -19e-22- PARCEL SIZE 3, 91 <br />OWNER NAME e / e _5 ,e, <br />OWNER ADDRESS /ei,e7 /1 / 'fa /fy 7 4:-; A. 3 e 4 i . Ok ? OA ,.. <br />i...ITY/STATE/ZIP <br />CONTRACTOR yet ./. e PHONE <br />CITY/STATE/ZIP .)/if , '''') C4 IcY 4 <br />NUMBER /59/346/4XPIRATION DATE <br />v 7z,9 CONTRACTOR ADDRESS <br />PHONE <br />LICENSE IA4-42 0=C-36 OTHER <br />BUILDING PERMIT # <br /> <br />LAND USE APPLICATION # <br />WATER TABLE DEPTH: 30 -3.3 <br />ft GEOGRAPHICAL INFORMAnON: Coordinates X <br /> <br />INSTALLATION WILL SERVE: <br /> <br />0 RESIDENCE 0 COMMERCIAL <br /> <br />0 OTHER <br /> <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br />0 PERC TEST # <br />TYPE OF WORK: L NEW INSTALLATION <br /> A REPAIR/ADDITION <br />REPLACEMENT C OUT-OF-SERVICE SEPTIC SYSTEM <br />ENGINEER DESIGNED /ALTERNATIVE <br />DESTRUCTION <br />5 <br />\ <br />ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />0 0 <br />CI <br />CI <br />0 <br />SEPTIC TANK <br />GREASE TRAP <br />LIFT STATION <br />TYPE/MFG <br />TYPE/MFG <br />DISTANCE TO NEAREST: <br />SIZE TYPE <br />WELL ft <br />OF PUMP <br />LEACH LINES 0 LEACHING CHAMBERS <br />DISTANCE TO NEAREST WELL /2-t2 ft <br />0 FILTER BED WIDTH ft LENGTH <br />DISTANCE TO NEAREST WELL ft <br />0 MOUNDED WIDTH ft LENGTH <br />DISTANCE TO NEAREST WELL ft <br />0 SUMPS WIDTH ft LENGTH <br />DISTANCE TO NEAREST WELL ft <br />0 DISPOSAL PONDS WIDTH ft LENGTH <br />DISTANCE TO NEAREST WELL ft <br />0 SEEPAGE PITS NUMBER WIDTH <br />DISTANCE TO NEAREST WELL ft <br />ft <br /># OF LINES .2- 1, i LENGTH OF LINES <br />FOUNDATION ft PROPERTY LINE II ' ft <br />ft DEPTH <br />ft PA Vila . inEN 7. FOUNDATION ft PROPERTY LINE ft <br />ft DEPTH ft etel Vet) <br />FOUNDATION ft PROPERTY LINE ft <br />ft DEPTH <br />" Es r 1 FOUNDATION ft PROPERTY LINE ' U 2027 <br />ft DEPTH $AN <br />°AQUIN FOUNDATION ft PROPERTY LINE CO <br /> <br />ft DEPTH HEAL IR°NMENTUNTY <br />FOUNDATION ft PROPERTY LINE 8 °EPARTAZ-NT <br />CAPACITY gal # OF COMPARTMENTS <br />CAPACITY gal # OF COMPARTMENTS <br />FOUNDATION ft PROPERTY LINE <br />El PKG TX PLANT 0 SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />I HEREBY CERTIFY THAT 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 />ifif04 971-27-1"7" <br />t SIGNED TITLE DATE eC <br />MINIMU .48 UF!)9V1.37E NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209)953-7697 6 <br /> C \Q rN?C"N <br />\ <br />et <br />At <br />0 <br />e <br />(3_ <br />Application Accepted Bix <br />Final Inspection By R <br />Character of Soil to Depth of 3 Ft: Pit/Sum Soil,Character: <br />I rIes rt)iriciri COMMENTS fel.' 1)11, 5y<117v1 xtst ; <br />50-1)4;11\ per L.,14L) retords.. <br />e A <br />DEPART ENT USE ONLY <br />Date att/L40 Area el) q ei Employee ID# is <br />)Date ' 2:2- "A 0 SPECIAL PERMIT - Approved by <br />AJowelk I-1 i' '1 <br />PE <br />Code <br />SC <br />INFO <br />Received <br />,B.m.,, <br />Chec <br />/ <br />Amount <br />Remitted Date Permit/ <br />Se ice Request # a Invoice # Permit ID# <br />LialD ilS- ‘..../R-----A(oet +3.) .2-N11i st4 od5zgli <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4/14/18