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JOB ADDRESS <br />CROSS STREET <br />OWNER NAME <br /> <br />2 Z 3 -7 0 . WE7-Le•1 ia-D • <br /> <br />f-1-1.A31.4. 8-k APN - coo -S'4 <br /> <br />PARCEL SIZE 5 . . <br /> <br />-n) DP> PrrvDcre-S en-0 — rk 4-1 Fe Y/0€ 5 PHONE 46-2 L" <br /> <br />--rtiLL.Li RD. <br />LItJ °Poe-- &Ey ENIVI on/Wicnfr L <br />CONTRACTOR ADDRESS <br /> Lio '7 LA) • Q wST. <br />crryisTATErzip At it1Y1 f:71) C-°t 1 5-2.2 t.) <br />PHONE 3(25- 03-11- <br />OWNER ADDRESS <br />CONTRACTOR <br />Crry/STATERip LCD I CA c-15-7-`4D <br />LICENSE 011C-42 C-36 OTHER GEC,- NUMBER 2-1 7 <br /> <br />EXPIRATION DATE (71 - 30 - <br /> <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 />WATER TABLE DEPTH: <br /> <br />ft GEOGRAPHICAL INFORMATION: Coordinates X <br /> <br />PERC TEST # <br /> <br />BUILDING PERMIT # LAND USE APPUCATION # <br /> <br />TYPE OF WORK: NEW INSTALLATION <br />REPLACEMENT c)O <br />o 0 REPAIR/ADDITION <br />0 OUT-OF-SERVICE SEPTIC SYSTEM <br />ENGINEER DESIGNED /ALTERNATIVE <br />DESTRUCTION <br />INSTALLATION WILL SERVE: 0 RESIDENCE <br />NUMBER OF LIVING UNITS: <br />COMMERCIAL <br />NUMBER OF BEDROOMS: <br />0 OTHER <br />NUMBER OF EMPLOYEES: <br />0 <br />0 <br />0 <br />SEPTIC TANK TYPE/MFG CAPACITY gal # OF COMPARTMENTS <br />GREASE TRAP TYPE/MPG CAPACITY gal # OF COMPARTMENTS <br />DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br />LIFT STATION SIZE TYPE OF PUMP 0 PKG TX PLANT 0 SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />0 LEACH LINES El LEACHING CHAMBERS # OF LINES LENGTH OF LINES ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />0 FILTER BED WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />0 MOUNDED WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />0 SUMPS WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />0 DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />0 SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <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 />MINIMUM 48 OUR AD NCE NOTICE RE UIRED FOR INSPECTIONS - PLEASE CALL 209 953-7697 <br />DATE 3 -9 - 2- 1 <br />OP" <br />om•ice / WA. <br />P2MILM4GG <br />Application Accepted By Date I/ap1 Area LI/qq Employee ID# <br />Final Inspection By Date 0 SPECIAL PERMIT - Approved by <br />DEPARTMENT USE ONLY <br />ECZ/frgo <br />Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br />COMMENTS <br /> <br />Se <br />ir 0 3 20 <br />21 <br />PE <br />Code <br />SC <br />INFO <br />Received <br />By <br />kCjigader <br />/ Cash <br />Amount <br />Remitted Date Permit/ <br />Service Request # Invoice # Per Mi*/#77•7; r," -•,. <br />i-JdaD .50?3 ykr/-7( IP, I 0 4/ Cg 3-9.-21 `,12, 00 ?;51-7-1 :SS311U(IV allS SIGNED <br />ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 42-01 <br />4/14/18