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LICENSE ei(-42 C-36 OTHER NUMBER 4/5"fel VSEXPIRATION DATE <br />OTYISTATEIZIP <br />PHONE 02° <br />CrryiSrxrEIZIp <br />OWNER ADDRESS e-V:: V/ <br />CONTRACTOR (.6014VC( 't/q <br />CONTRACTOR ADDRESS 3 V`fa <br />PROPERTY LINE ft <br />LAND USE APPLICATION # PERC TEST if BUILDING PERMIT # <br />TYPE OF WORK: EW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED /ALTERNATIVE <br /> <br />REPLACEMENT I, / OUT-OF-SERVICE SEPTIC SYSTEM ;:o DESTRUCTION -5e I( I /. <br />TYPE/MFG Ajr64 1.^LC_ <br />TYPE/MFG <br />if OF COMPARTMENTS <br />gal if OF COMPARTMENTS <br />CAPACITY /1:906) gal <br />CAPACITY <br />ft FOUNDAllON All1P.S" 'ft <br />IS <br />f SEPTIC TANK <br />GREASE TRAP <br />INSTALLATION WI SERVE: KRESIDENCE COMMERCIAc3 OTHER <br />LIVING NUMBER OF LNG UNITS: d_-- NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br />DISTANCE TO NEAREST: WELL Plibe./. C <br />ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. NAZELTON AVENUE -STOCKTON CA 95205 - (209)468-3420 <br />NON-REFUNDABLE PERMIT CALL (209) 953-7697 FOR INSPECTIONS EXPIRES) YEAR FROM DATE ISSUED <br />D. Oki <br /> <br />CirelZie <br />rtz,) I et 44.10— APN C'ieW(-;0.20 PARCEL SIZE <br />Peotv tzo Gchom <br />PHONE <br />JOB ADDRESS <br />CROSS STREET <br />OWNER NAME <br />WATER TABLE DEPTH: 70 -rD ft GEOGRAPHICAL INFORMATION: Coordinates X <br />pte LIFT STATION SIZE <br />)friV Ar LEACH LINES LEACHING CHAMBERS # OF LINES I LENGTH OF LINE:, <br />DISTANCE TO NEAREST WELL P-e-A4t- ft FOUNDATION /0 f ft PROPERTY LINE <br />FILTER BED WIDTH ft LENGTH ft DEPTH <br />TYPE OF PUMP PKG TX PLANT U SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />Y4 1 E 2OEN <br />DSTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE <br />DE vs. <br />QUIN <br />CYn 4 <br />EVD7 <br /> ft PROPERTY LINE <br /> ft DEPTH ft <br /> ft PROPERTY LINE <br />3 <br />21 DEPTH <br /> ft PROPERTY UNE 8ANj <br /> <br />ft PROPERTY UNE DEPARTMENT <br /> ON N ECOTAULN Ty rHEA <br />MINIMUM 48 HOUR AD ANCE N •TICE REQUIRED FOR INSPECTIO S - PLEASE CALL (209)953-7697 <br />SIGNED ."0" OF V TITLE DATE <br />Application Accepted ..---7) 2-- / _ <br /> PEPARTMEN4 U ; E ONLY <br />Date &. Le ? / Area Li J) 6:1 r- Employee IN D A <br />Final Inspection By Date 71_.> SPECIAL PERMIT - Approved by C I/ p 6.7 r- p(..„ <br />Character of Soil tjupepilt of Pt: Pit/Su p Soil Character: <br />COMMENTS 1-6,1) 1 I ne‘...y5--ie tvl , fi., ii rep icte eivi fil f-- 140 fee I- of ),....“., 0 1 inc., I, : t 14 c/571-0 e <br />Vepth ciedif qA Frtti ,Lk cleptii wiiil c?ii inches ti-c. roc i if ncleNiec-41 . .1; vi perci j-i <br />ei-weem pi 1- cppwad to .1: (eel- iF retuilvd p er fcrr Cwrdi a 4 ..-.)r 1-0,6,/ -th Ice, p il....c elk <br />enc/ 6( hi. ?e <br />42-01 Pt-i it my! er pe r; ,wwt, y <br /><10Jble Cleprfri tat e 4,,rid /;/ rm p is‘ <br />4/14/18 s ONtITE WASTEWATER TRTMNT SYSTEM PERMIT I . I <br />DISTANCE TO NEAREST WELL ft FOUNDATION <br />SUMPS WIDTH ft LENGTH <br />DISTANCE TO NEAREST WELL <br />0 MOUNDED WIDTH ft LENGTH ft DEPTHPTH <br />ft FOUNDATION <br />DISPOSAL PONDS Worn ft LENGTH ft <br />DISTANCE TO , T,..- WELL UNDATI O N <br />)( SEEPAG E PITS NUMBER <br />, <br /> (... (3) AlTH Li / <br />DISTANCE TO NEAREST WELL 4r"61; t.... ft FOUNDATION AD' <br />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 />PE <br />Code <br />SC <br />FO <br />Received <br />_By_ <br />I't Amount <br />Remitted Data Permit/ <br />Service Reotlest if Invoice # <br />- <br />Permit ID# <br />LP/3 0 S- diV p2 40V) V 1/4-)`') 511414 ..59-00 -4.6(11