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INSTALLATION WILL SERVE: RESIDENCE COMMERCIAL I OTHER PL3 1- TYPE/MFG TYPE/MFG CAPACITY DISTANCE TO NEAREST: WELL 11/4')//A, ft FOUNDATION CAPACITY 16 c, NUMBER OF EMPLOYEES: gal # OF COMPARTMENTS gal # OF COMPARTMENTS ft PROPERTY LINE ft LICENSE C-42 C-36 OTHER PH. 9/6 — 366 - I/1 cayisTATEizip /.0) 95693 NUMBER /Oh lO XPIRA11ON DATE go "*. 1 --- Z./ PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION ( ENGINEER DESTNED /ALTERNATIVE .K REPLACEMENT le, k OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION It' 1,114-, ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209)468-3420 WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X NON-REFUNDABLE PERMIT CALL (209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS '$O .5- /4 fro A.,--Arc LAA- crrylz,p 4-r ,,,..1_,, 6' /A c-i" s zcz APN 08 (.; i -V-,) ) PARCEL SIZE # 3LI PHONE -zog OWNER ADDRESS q g—e) S.— hi /1/16-Ctre (1 ',Lye. CITY/STATE/ZIP S -655 C- k--- let---i , 44 9 S: Zi -L CROSS STREET 15 1ac 4-f:97 t'iZ OWNER NAME 772.4. /7 6,e-C-7 4) CONTRACTOR 5 sr-frt Se nieces 62014_1' CONTRACTOR ADDRESS LIFT STATION SIZE TYPE OF PUMP U PKG TX PLANT CI SAND OIL SEPARATOR (ENCLOSED SYSTEM) SEPTIC TANK GREASE TRAP NUMBER OF BEDROOMS: NUMBER OF LIVING UNITS: LEACH LINES LEACHING CHAMBERS # OF LINES LENGTH OF LINES ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft FILTER BED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft MOUNDED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft SUMPS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft SEEPAGE PITS NUMBER WIDTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY UNE ft - . I 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. MINIMUM 48 HOUV. 1D4ANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209)953-7697 SIGNED TITLE )2_ th DATE dit z, 16, 04 0 PA yw. Reczit,lEvig: APR 2 0 2021 SAN jo4 4 QL8N CO LT ROAjw ., UNry MEArr Application Accepted By DEPARTMENT US/ONLY Final Inspection By 1-- Z-- SP C- Date LiAkky) Area 11/ ("?6/ Employee ID# DA Date IAL PERMIT - Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS koK)-t- u i ink. /Jew ti,34 my) nit./ 01-bcoe illsreied Did Wolk re troved. ' cncler cirAek•JC: b, toid PE " Code SC Received INFO Check#I Amount Remitted Date Permit/ aervice Requ2st#,_ .„.., Invoice # Permit ID# orf 1 1 ''' z ita itsh j‘sej._ t33 -0 1,11-i saon3491)‘ 42-01 4/14/18 /2#3-Ys-213 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT