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CITY/ZIP <>Le, 7)-7,/1 _ OWNER NAME ,fr ex I, e t.- APN tRia Y3d0 PARCEL SIZE it q PHONE • r..0:2_ /b7 6- JOB ADDRESS //7‘.-7 /,''2r,4/ CROSS STREET 4//ev OWNER ADDRESS r7R I CITY/STATE/ZIP RirDr1 s 366, CONTRACTOR Zetlee;,/,,,Aityl• f- e - PHONE 2-ef q —A47 ye CONTRACTOR ADDRESS /4"2.-;14 i--2/4")./ CITY/STATE/ZIP LICENSE O r:C-42 I_ C-36 OTHER NUMBER ] .---7,77237 EXPIRATION DATE WATER TABLE DEPTH: /do -130 ft GEOGRAPHICAL INFORMATION: Coordinates X 0 PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # • 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) 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED TYPE OF WORK: NEW INSTALLATION REPLACEMENT REPAIR/ADDITION OUT-OF-SERVICE SEPTIC SYSTEM ENGINEER DESIGNED /ALTERNATIVE DESTRUCTION A RESIDENCE INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS: 0 COMMERCIAL NUMBER OF BEDROOMS: 3 0 OTHER NUMBER OF EMPLOYEES: SEPTIC TANK GREASE TRAP El LIFT STATION TYPE/MFG CAPACITY gal # OF COMPARTMENTS TYPE/MFG CAPACITY gal # OF COMPARTMENTS DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft SIZE TYPE OF PUMP 0 PKG TX PLANT 0 SAND OIL SEPARATOR (ENCLOSED SYSTEM) b .)LEACH LINES FILTER BED MOUNDED SUMPS DISPOSAL PONDS )61 SEEPAGE PITS # OF LINES LENGTH OF LINES 11 ft ft FOUNDATION 10 ft PROPERTY LINE ft ft DEPTH ft ft PROPERTY LINE ft ft ft ft ft ft ft PROPERTY LINE ft ft DEPTH -2. -, ft WELL / ft FOUNDATION 2P /-2. ft PROPERTY LINE ft - LEACHING CHAMBERS DISTANCE TO NEAREST WELL 3-7&. WIDTH ft LENGTH DISTANCE TO NEAREST WELL ft FOUNDATION WIDTH ft LENGTH ft DEPTH DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE WIDTH ft LENGTH ft DEPTH DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE WIDTH ft LENGTH ft DEPTH DISTANCE TO NEAREST WELL ft FOUNDATION NUMBER WIDTH 5'16 DISTANCE TO NEAREST 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. MIN M 48 HOUR ADV NCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 SIGNED TITLE DATE 0 1 (7" ee vE0 DEC 10 sANE, -10AQuINc HEALIVVIT'FiRSOptlit- 11°G4LUArrv" WW I 2020 REca :SSMICRIV 31IS PE Code SC INFO Received" By _Ches_kg/ --rish Amount Remitted Date ' Permit/ Service Request # Invoice # _ Permit ID# 92 ID i/S— 1,6 J. lel 3 og 4300 L'Ili o (,7 12-0() ggf9/5 Application Accepted Final Inspection By des;...• • Datel/ poa-k 0 SPECIAL PERMIT - Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS Let,CAII Ies -1;1 ;111 )1,5. L'xiJiij i/Sh-rr oti rAdbi:13 i9;11 tree 4- 1,5-0' rroPr7 Pi Is tz2 iSk f i'rtS vqelis No' to Of I ) oh 1,-/Dpf 17 O./ p IV • t L'eLt_ ; eci_ tivi' tjO /01-i l ) te4tA_k-1L-r-e4-761.7 e pr a—s '/ —52 ;0. due-746 Qpir DEPARTMEN/ U)E ONLY hp 30) Date/9 0 Area Li/gq Employee ID# -DA 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18