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LICENSE OpIG-42 C-36 OTHER NUMBER V5-**593-- EXPIRATION DATE 0 / <br />.01,26 33 Si9,-)7.ro <br />/ty4c <br />74 <br />CITY/STATE/ZIP <br />PHONE 7Y?-A'30 <br />el nip° qs-da <br />PHONE .769-5-0'z7 <br />GEOGRAPHICAL INFORMATION: Coordinates X ft WATER TABLE DEPTH: <br />ENGINEER DESIGNED /ALTERNATIVE <br />DESTRUCTION <br />S.- REPAIR/ADDITION <br />OUT-OF-SERVICE SEPTIC SYSTEM <br />NEW INSTALLATION <br />REPLACEMENT <br />I I <br />INSTALLATION WILL SERVE: 0- RESIDENCE <br /> E COMMERCIAL <br />NUMBER OF LIVING UNITS: I NUMBER OF BEDROOMS: <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 />111 PERC TEST # <br />TYPE OF WORK: <br />BUILDING PERMIT # LAND USE APPLICATION # <br />CITY/ZIP )Vk,11726, S-ddO <br />APN 0073 7 016 PARCEL SIZE 1-1° <br />E}e}‹, 44j 4 AG <br />OWNER ADDRESS da 6 33 •SgrY1r-01 140\ ye <br />///er <br />CONTRACTOR ADDRESS 32v..4 22z'% PC. CITY/STATE/ZIP <br />CONTRACTOR <br />JOB ADDRESS <br />CROSS STREET <br />OWNER NAME <br />NUMBER OF EMPLOYEES: <br />0 OTHER <br />TYPE/MFG <br />TYPE/MFG <br />DISTANCE TO NEAREST: WELL <br />SIZE TYPE OF PUMP <br /> CAPACITY /60-0 gal # OF COMPARTMENTS <br /> CAPACITY gal # OF COMPARTMENTS <br />ft FOUNDATION ft PROPERTY LINE ft <br />PKG TX PLANT 0 SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />SEPTIC TANK <br />GREASE TRAP <br />LIFT STATION <br />$1— LEACH LINES <br />FILTER BED <br />MOUNDED <br />SUMPS <br />DISPOSAL POND <br />SEEPAGE PITS <br />DISTANCE TO NEAREST <br />WIDTH <br />DISTANCE TO NEAREST <br />WIDTH <br />DISTANCE TO NEAREST <br />WIDTH <br />DISTANCE TO NEAREST <br />S WIDTH <br />DISTANCE TO NEAREST <br />NUMBER <br />DISTANCE TO NEAREST <br />ft <br />WELL / 52> ft FOUNDATION ft PROPERTY LINE ft <br />ft LENGTH ft DEPTH ft <br />WELL ft FOUNDATION ft PROPERTY LINE ft <br />ft LENGTH ft DEPTH ft <br />WELL <br /> ft FOUNDATION ft PROPERTY LINE ft <br />ft LENGTH ft DEPTH ft <br />WELL <br /> ft FOUNDATION ft PROPERTY LINE ft <br />ft DEPTH ft <br /> <br />ft PROPERTY LINE <br /> <br />ft <br /> <br />ft DEPTH <br /> <br />ft <br /> <br />ft PROPERTY LINE 5-0.* <br />ft <br />I LEACHING CHAMBERS <br /> <br /># OF LINES / LENGTH OF LINES <br />ft LENGTH <br />WELL ft FOUNDATION <br />WIDTH <br />WELL /cp ft FOUNDATION <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 />SIGNED <br />MINIMUM 48 UR ADVANCE NOTICE REQUIRED FOR INSPECTION - PLEASE CALL (209)953-7697 <br /> TITLE ..-90/ art_ DATE 2/ 7-0 <br />Se <br />Application Accepted <br /> 2••• 2— <br />DEPARTMENT U,E ONLY <br /> Date /eVaP/ a/:>07 0 Area LI /6/q <br />Final Inspection By <br />Employee ID# <br />Date12* Zrai) E SPECIAL PERMIT -Approved by <br />Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br />COMMENTS Foe /t; !(? t)1 Iiiie i/F r,).) in/CPS' 141 j/1/V? set6mcks per Eqb ree orCk. <br />clip 91— SS OkAe_ e?Q;3.6.7 <br />PE <br />Code <br />SC <br />INFO <br />Received <br />By <br />(hecis.#f <br />Cash <br />Amount <br />Remitted Date Permit/ <br />Service Request # Invoice # Permit ID# <br />/4010 ils- iAAT/6 /-l-1111 '?i3c) 12..2-1 • TO SoDiDk-{g. <br />ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />Les,d4 <br />42-01 <br />4/14/18