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JOB ADDRESS / 33 <br /> <br />CITY/ZIP <br /> <br />CROSS STREET <br />OWNER NAME <br /> <br />APN '3D <br /> <br />PARCEL SIZE <br /> <br />PHONE <br /> <br />CONTRACTOR ADDRESS CITY/STATE/ZIP <br />LICENSE V---C-42 OC-36 OTHER NUMBER ,‘,4 12-'S EXPIRATION DATE 6 <br />CITY/STATE/ZIP <br />PHONE <br />OWNER ADDRESS e <br />CONTRACTOR <br />PERC TEST # <br />TYPE OF WORK: E NEW INSTALLATION <br />Li REPLACEMENT <br />BUILDING PERMIT # LAND USE APPLICATION # <br />c_t4e... REPAIR/ADDITION <br />CI OUT-OF-SERVICE SEPTIC SYSTEM <br />ENGINEER DESIGNED /ALTERNATIVE <br />DESTRUCTION <br />SEPTIC TANK TYPE/MFG <br />GREASE TRAP TYPE/MFG <br />DISTANCE TO NEAREST: WELL <br />LIFT STATION SIZE TYPE OF PUMP <br /> CAPACITY gal # OF COMPARTMENTS <br /> CAPACITY gal # OF COMPARTMENTS <br /> ft FOUNDATION ft PROPERTY LINE ft <br />PKG TX PLANT CI SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />COMMENTST-c, r, t,,- .5)(5, _J ExiIiv.),s kI rei-0‘)1- )9/ bc“--/c• <br />DEPARTMENT USE ONLY <br /> Date OA? 1 <br />Date/S/ô Zj <br />Employee ID# ri <br />El SPECIAL PERMIT - Approved by <br />Area Application Accepted <br />Final Inspection By <br />Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br />ivixik <br />0 9/1 <br />Q0/41 Oro CO, <br />°€/a47,611.' u417)' xl,p 7,4 AIZ <br />./ <br />‘9,1, <br />MINIMUM 48 HOUR <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 />WATER TABLE DEPTH: / ) ft GEOGRAPHICAL INFORMATION: Coordinates X <br /> <br />INSTALLATION WILL SERVE: <br />NUMBER OF LIVING UNITS: <br />eP-- RESIDENCE 0 COMMERCIAL <br /> E OTHER <br />NUMBER OF BEDROOMS: <br /> 3 <br />NUMBER OF EMPLOYEES: <br />LEACH LINES LEACHING CHAMBERS # OF LINES i LENGTH OF LiNiEs j(i' / ft <br />DISTANCE TO NEAREST WELL ,/ c-,C-,.; ft FOUNDATION .6c ' ft PROPERTY LINE 57) ft <br />FILTER BED WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />MOUNDED WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />SUMPS WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />SEEPAGE PITS NUMBER 4-2-- WIDTH 13 ft DEPTH ,25---' ft <br />DISTANCE TO NEAREST WELL ,,i(> C-r3 ft FOUNDATION /- S— ft PROPERTY LINE c-2-% 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 />ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209)953-7697 <br />TITLE <br />PE <br />Code <br />SC <br />INFO Cash <br />ReceivedCctuaGli#07 Amount <br />Remitted Date Permit/ <br />Service Request # Invoice # Permit ID# <br />Lid )0 1)5" d;','2. 71--3.1 4-30- S.)0- Z4 5 \IZCIO3(.0'Sei <br />42-01 <br /> <br />ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />DATE <br />4/14/18