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CAPACITY <br /> CAPACITY <br />ft FOUNDATION <br /> gal # OF COMPARTMENTS <br />gal # OF COMPARTMENTS <br />ft PROPERTY LINE <br />O COMMERCIAL <br />NUMBER OF BEDROOMS: <br />CI OTHER <br />NUMBER OF EMPLOYEES: <br />INSTALLATION WILL SERVE: ID RESIDENCE <br />NUMBER OF LIVING UNITS: <br />CI SEPTIC TANK <br />I:I GREASE TRAP <br />TYPE/MFG <br />TYPE/MFG <br />DISTANCE TO NEAREST: WELL ft <br />()) <br />ft PROPERTY LINE <br />LENGTH OF LINES <br />oNsrrE 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 />JOB ADDRESS g8s---0 <br />CROSS STREET -A) 7%t'.}3r APN <br />OWNER NAME 14-eUt'A ci- <br />PARCEL SIZE I t 1f-3 <br /> <br />PHONE <br /> <br />0.6 1- io4Lfr <br /> <br />OWNER ADDRESS <br />CONTRACTOR kt„, Li elc fim7 ),41, <br />CrrY/STATEIZiP <br />PHONE q31-1glyii <br />CONTRACTOR ADDRESS CITY/STATE/ZIP <br />LICENSE LIC-42 IDIJC-36 OTHER <br /> <br />NUMBER 24-o.70f.,, EXPIRATION DATE /a-721-10 <br /> <br />WATER TABLE DEPTH: go ft GEOGRAPHICAL INFORMATION: Coordinates X <br /> <br />CI PERC TEST # <br />TYPE OF WORK: C NEW INSTALLATION <br />E1 REPLACEMENT <br />BUILDING PERMIT # LAND USE APPLICATION # <br />;14-- REPAIR/ADDITION <br />n OUT-OF-SERVICE SEPTIC SYSTEM <br />D ENGINEER DESIGNED /ALTERNATIVE <br />D DESTRUCTION <br />ta LIFT STATION SIZE TYPE OF PUMP <br /> <br />0 PKG TX PLANT SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br /> <br />0— LEACH LINES El LEACHING CHAMBERS # OF LINES <br />ft FOUNDATION JO 7-2, <br />Di FILTER BED WIDTH ft LENGTH <br />ft DEPTH <br />DISTANCE TO NEAREST WELL <br />DI MOUNDED WIDTH ft LENGTH <br />DISTANCE TO NEAREST WELL <br />El SUMPS WIDTH ft LENGTH <br />DISTANCE TO NEAREST WELL <br />01 DISPOSAL PONDS WIDTH ft LENGTH <br />WELL <br />• <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 />MI UM 48 HOUR A VANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 <br />-, •,...4------ -/- TITLE C 10 DATE q -*--?) - 9,, 0 <br />Ad SEEPAGE PITS <br />DISTANCE TO NEAREST WELL <br /> <br />ft FOUNDATION ft PROPERTY LINE <br />ft DEPTH <br />DISTANCE TO NEAREST WELL /1)0 /4, ft FOUNDATION /0 1-1' ft PROPERTY LINE <br />DISTANCE TO NEAREST <br />NuMBER WIDTH <br />ft FOUNDATION <br />ft FOUNDATION <br />ft FOUNDATION <br /> ft PROPERTY LINE <br />ft DEPTH <br /> ft PROPERTY LINE <br />ft DEPTH <br /> ft PROPERTY LINE <br />ft DEPTH <br />ft <br />ft <br />ft <br />ft <br />ft <br />ft <br />ft <br />ft <br />ft <br />ft <br />ft <br />ft <br />oryt 114— rin <br />toelts <br />Application Accepted By <br />Final Inspection By <br />Character of Soil to Depth of 3 Ft: <br />COMMir CLe..- /14( <br />OtA)75 <br />IrevTZJ 601-6)1707,1 <br />;s <br />Pit/ imp Soil Character: <br />CI SPECIAL ERM IT - AppSEtp u <br />tatT4 eit3VIL RoP4morA <br />,Ls-e12-_ ink reco rri r <br />(Add i <br />j <br />t 6-e diot-e. <br />Area Em p I oywr,14 )._ <br />PE <br />Code <br />SC <br />INFO <br />Received <br />By <br />(CheclsW Amount <br />Remitted Date Permit/ <br />.Service Request # <br />Invoice # Permit ID# -C-ash <br />42.1.0 ii 5- y M116- C,(2 i*2-0 5Z 0004114 <br />42-01 <br /> ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4/14/18