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0 LEACHING CHAMBERS <br />DISTANCE TO NEAREST <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />DISTANCE TO Ni5JREST <br />WIDTH <br /> <br />I <br /> <br />WIDTH ft <br /># OF LINES LENGTH OF LINES ft <br />WELL . ft FOUNDATION ft PROPERTY LINE ft <br />ft LENGTH 10 SO ft DEPTH 2- ft <br />WELL 1 (-D A--/..:: ft FOUNDATION toY- ft PROPERTY LINE 3 5 *X-- ft <br />ft LENGTH ft DEPTH <br />S. <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 />JOB ADDRESS 2050 S I-I f4 I I j 01;a4 ClAkS__BITY/ZIPt 5-301-/ <br />CROSS STREET .5 1 Aki. kW APN 1- 12 -Id 0-Z0 PARCEL SIZE I 1 0 <br />OWNER NAME PHONE <br />OWNER ADDRE <br />CONTRACTOR <br />Ktilir (-00c bee CITY/STATE/ZIP <br />11 2 5 S. Clreyor A\le PHONE I 04 —24 1 '' 1-,Y2 zi <br />CONTRACTOR ADDRESS CITY/STATE/ZIP <br />LICENSE DUG-42 LIC-36 OTHER "5 NUMBER (7) (g14-EXPIRATION DATE <br />WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X <br />El P E RC TEST # BUILDING PERMIT # LAND USE APPLICATION # <br />TYPE OF WORK: r NEW INSTALLATION <br />CI REPAIR/ADDITION <br />O ENGINEER DESIGNED /ALTERNATIVE <br />REPLACEMENT <br />rI OUT-OF-SERVICE SEPTIC SYSTEM <br />O DESTRUCTION <br /> <br />INSTALLATION WILL SERVE: 0 RESIDENCE <br /> <br />0 COMMERCIAL 0 OTHER <br /> <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: :SSMICNIV aLIS SEPTIC TANK <br /> <br />TYPE/MFG CNA( R0r7 xe rw e5 <br />Di GREASE TRAP <br /> <br />TYPE/MFG <br />DISTANCE TO NEAREST: WELL ft <br />14. LIFT STATION <br /> <br />SIZE 1/2 he TYPE OF PUMPZ-0 der CI <br />Zi LEACH LINES <br />it FILTER BED <br />MOUNDED <br />SUMPS <br />CAPACITY 2000 "I/ gal # OF COMPARTMENTS 2 <br />CAPACITY gal # OF COMPARTMENTS <br />FOUNDATION ft PROPERTY LINE <br />ft <br />PKG TX PLANT ID SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />la DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />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 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209)953-7697 <br />SIGNED EgrktS(144k TITLE likt( DATE (3— <br />ZO;St.c.i'llt4Y 4`k 0 x cts'L 41' 1);14-;$),S. ki b,), <br /> `4441-ht4 <br />( <br />. —3 f114-t2y- 49c4( <br />m=mINIIME11.1 <br />ISEet <br />IMMEN• <br />RecgtE/Nr 80 <br />6 71)9,1 <br />t alvAyvolotliN buiu <br />HEAL vville -Lfivr DepA <br /> A <br />S5(014 <br />DEPARTMENT USEpNLY <br />Date l 6 //5? e'70 Area 5 el q Employee ID# <br />Date $ / i 4 Z02-1 0 SPECIAL PERMIT - Approved by <br />Pit/Sump Soil Charafter: <br />i <br />44 Ctj 0 r F)1C.t..ce <br />PE`i <br />Code <br />SC <br />INFO <br />'Received Check#/ <br />Cash <br />Amount <br />Remitted Date Permit/ <br />Service,Zequest <br />r <br />Invoice # Permit ID# <br />4,231 531 <br />Zig, <br />vi s, t3iblob s 604.2t) qoox <br />,10.7.2r)---cfacomti-10 <br />tv.k1e). <br /> J <br />cob <br /> 6 <br />JUN_ <br />PA le <br />Application Accepted By <br />Final Inspection By <br /> <br />Character of Soil netiii <br />COMMENTS ' <br />0 13 Ft: I MIM <br />,Inipec--(i OTIS a jetC <br />rck CYI -OVAA1 er34 1412 44 <br />41-02-4P. YJ4A01- s i wo f -re-licacit <br />s4-ct iv& r c,J.' os ffir4V4 <br />ONSfTE WASTEWATER TRTMNT SYSTEM PERMIT <br />4/14/18 <br /> <br />i/O/7th7/