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0 PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # <br />te---REPAIR/ADDITION 0 ENGINEER DESIGNED /ALTERNATIVE <br />rl OUT-OF-SERVICE SEPTIC SYSTEM <br /> <br />Li DESTRUCTION <br />TYPE OF WORK: o NEW INSTALLATION <br />El REPLACEMENT <br />M1NjIR4 48 Ham V CE NOTICE QUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 <br />TITLE <br /> <br />DATE 12 --c2e ,25 SIGNED <br />i -r A9p <br />Area Ll/q cf Employee ID# DA <br /> Date V510—VQ,/ <br />Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br />COMMENTS Sycl-'ernv401- k ni 5 Li4 • Fe.litne 1 bvs • Ver AJTN thekS <br />p er 41) f ec..fais., fron Qt.p-Ni • 5 . Jute- "t. e).41649 Sykit~i <br />Final Inspection By <br />DEPARTMENT U§E ONLY <br />Date ha la gi?oato <br />0 SPECIAL PERMIT - Approved by <br />Nr Receive° <br />8 <br />j„..J0,41 <br />vitii <br />-uuntry . FATAL <br />PA <br />Application Accepted B <br />4. , <br /> exiS th,frpt <br />A <br />/co> <br />Nk <br />ONS TE WASTEWATER TREATMENT SYSTE PERMIT — <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAzELToN AVENUE - STocKioN CA 95205 (209) 468-3420 <br />NON-REFUNDABLE PERMIT CALL (209) 953-7697iFoR INSPECTIONS XPIRES 1 YEAR FROM DATE ISSUED <br />JOB ADDRESS Id E6 CITY/ZIP <br />APN CGS-07 017 <br />PARCEL SIZE <br />Rg orkil Arflur Cesew Sennifer rYlorip -Fr PHONE <br />OWNER ADDRESS CITY/STATE/ZIP <br />CONTRACTOR <br />CONTRACTOR ADDRESS /19g a.7 <br />/f) ?//14(y4 G - <br />LICENSE El LIC-42 UC-36 OTHER Ai dk. NUMBER e5—C, 76.5 EXPIRATION DATE //, <br />WATER TABLE DEPTH: Li° — /5-() <br />a <br />ft GEOGRAPHICAL INFORMATION: Coordinates X <br /> <br />INSTALLATION WILL SERVE: 4.4iLRESIDENCE <br /> <br />El COMMERCIAL <br /> <br />0 OTHER <br /> <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: 1 <br />NUMBER OF EMPLOYEES: <br />z <br />PHONE f2i <br />CITY/STATE/ZIP St;" fdlef60.11i.4 q$-/f :SSallaCIV alIS SEPTIC TANK <br /> <br />TYPE/MFG CAPACITY gal # OF COMPARTMENTS <br />GREASE TRAP <br /> <br />TYPE/MFG CAPACITY gal # OF COMPARTMENTS <br />DISTANCE To NEAREST: WELL ft FOUNDATION <br /> <br />ft PROPERTY LINE <br /> <br />ft <br />101 LIFf STATION <br /> <br />SIZE TYPE OF PUMP <br /> <br />PKG TX PLANT <br /> <br />SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />0 LEACHING CHAMBERS katEACH LINES <br />FILTER BED <br />[3.3 *MOUNDED <br />SUMPS <br />DISTANCE TO NEAREST <br />D PPOSAL PONDS WIDTH <br />DISTANCE TO NEAREST <br />SEEPAGE PITS NUMBER <br /># OF LINES 005 I LENGTH OF LINES 4/() <br />WELL _ Jo b i ft FOUNDATION lb ' ft PROPERTY LINE <br />ft LENGTH ft DEPTH <br />WELL ft FOUNDATION ft PROPERTY LINE <br />ft DEPTH <br />ft FOUNDATION ft PROPERTY LINE <br />23— ) ft DEPTH / 7 ) <br />ft FOUNDATION ft PROPERTY LINE <br />ft LENGTH <br /> ft DEPTH <br />WELL <br /> <br />ft FOUNDATION <br /> <br />ft PROPERTY LINE <br />WIDTH <br /> ft DEPTH <br />DISTANCE TO NEAREST <br />WIDTH <br />DISTANCE TO NEAREST <br />WIDTH <br />DISTANCE TO NEAREST <br />WIDTH <br /> P-1 <br />ft LENGTH <br />WELL <br />ft LENGTH <br />WELL <br />ft <br />ft <br />ft <br />ft <br />ft <br />ft <br />ft <br />ft <br />ft <br />ft <br />ft <br />ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE <br />I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN QUIN COUNTY ORDINANCES, <br />STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br />PE <br />Code <br />SC <br />INFO <br />Received lz <br />By r <br />... ) tZteclw Amount <br />Remitted Date Permit/ <br />Service Request # Invoice # Permit ID# <br />Cash <br />115 miti/`Ad)0 el 8 Li-4- 4•300 P-124120 90)073010 <br />ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 42-01 <br />4 /14/18