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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 (2091953-7697 FOR INS9TIPE ONS EXPIRES 1 YEAR FROM DATE ISSUED <br />JOB ADDRESS 04s-(9) ix/ --6:;/,,›s /4- Zi4./c_e_ •Cifitzip IlLid.30(:) <br />.-. <br />CROSS STREET lelWrie _cnc...... APN 0033 3..? I PARCEL SIZE gE 3 ; <br />OWNER NAME iCe114-/C. ee<ci ricinitS - Fl (Ink p.., rkf I C., PHONE <br />c I i <br />OWNER ADDRESS <br /> <br />fl 5S 5S- D-0,j m i' it hell Pl4e crryisTATErzip S ID ( kit) V) 7s-,,)0 q <br />CONTRACTOR e,,/ .,,h,,,Z 14::9././L" C.. PHONE '36.- coZ7 <br />CONTRACTOR ADDRESS 32 VC 2"--,./C- PXCrry/STATE/ZIP 3kie./44A-i <br />LICENSE L 42 D C-36 OTHER NUMBER 11 EXPIRATION DATE 47.0r, <br />WATER TABLE DEPTH: 1(3-3 <br />Li PERC TEST # <br />ft GEOGRAPHICAL INr,flpJ r'-,rdinates X y <br />BUILDING PERMIT IclogS"q7 I A —ND USE APPLICATION # <br />TYPE OF WORK: NEW INSTALLATION ), <br />REPLACEMENT <br />REPAIR/ADDMON ENGINEER DESIGNED /ALTERNATIVE <br />OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> <br />INSTALLATION WILL SERVE: O-.RESIDENCE D COMMER0IAL <br /> <br />NUMBER OF LIVING UNITS: ) NUMBER OF BEDROOMS: <br /> <br />TYPE/MFG <br />TYPE/MFG CAPACITY gal # OF COMPARTMENTS <br />DISTANCE TO NEAREST: WELL / 5-0 'X'" ft FOUNDATION ce) fl PROPERTY LINE ?CV /- ft <br />CI LIFT STATION SIZE TYPE OF PUMP <br />LEACH LINES LEACHING CHAMBERS # OF LINES 3, LENGTH OF LINES /00 ' ft <br />DISTANCE TO NEAREST WELL 20C1- ft FOUNDATION 75- ft PROPERTY LINE ZOO e'" ft <br />0 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 11 <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 VlItecrU ft DEr .„ r_....- ft <br />DISTANCE TO NEAREST VVEL ft FOUNDATION ft PROYLII I I 1-11•1-,.. _ ft <br />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 />MINIM 48 HOUR DVANCE NOTICE REQUIRED FOR INSPECTIO S - P EASE CALL (209)953-7697 <br />SIGNED TITLE _2 L2 — <br />CI OTHER <br />NUMBER OF EMPLOYEES: <br />A SEPTIC TANK <br />CI GREASE TRAP <br /> <br />CAPACITY ir,200 gal # OF COMPARTMENTS 44 <br /> <br />PKG TX PLANT 0 SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />0 <br />it? Qe/ <br />ed <br />.5 <br />a 0 'V ,1. 2020 <br />1)4. 1,,, ,/,,, <br />)'41k) - — CO <br />0 411%,1144.• 7., 4 <br />11447. 14 <br />Date <br />4. <br />• <br />PE <br />Code <br />SC <br />INFO <br />Received <br />By sh <br />Amount <br />Remitted <br />Permit/ <br />Service Re (Jest # Invoice # Permit ID# <br />9,0 1 I 7 UAR-61--511( Q9- I'S 81.1 <br />cate <br />R 5 20 C,;(40 3-1 <br />Application Accepted B <br />Final Inspection By <br />Character of Soil to Depth of 3 Ft: <br />COMMENTS A‘leti ,ey <br />0 14 <br />pEPARTMENT USIE ONLY <br />—11q-e i Date /.3 ' ) .., : Area . i Employee lD# <br />5141Z- 1 ti SPECIAL PERMIT - Approved by <br />, Pit/Sump Soil Character: <br />v..- Tr h 1 ,1 j (.1l7 &. COU'i Se iC1 1 Ve C 'I-. EL1'-.,-)A14' C <br />4 42-01 <br />4/14/18 <br />a( 'e <br />L900 , <br />vco- 'on 6k i <br />ONSITE WASTEWATER T T SYSTEM ERMIT (9