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APN <br />OWNER ADDRESS CITY/STATE/ZIP <br />WATER TABLE DEPTH: Li 0 - CI) <br />PERC TEST # <br />ft GEOGRAPHICAL INFORMATION: Coordinates X <br />BUILDING PERMIT # 6 pd000 C71 LAND USE APPLICATION # <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 />TYPE OF WORK: 451c <br />Li REPLACEMENT <br />[1] ENGINEER DESIGNED /ALTERNATIVE <br />OUT-OF-SERVICE SEPTIC SYSTEM P DESTRUCTION <br />REPAIR/ADDITION NEW INSTALLATION <br />CONTRACTOR 24 Cer,, ,a1Z C;5‘?/1C-• PHONE .36 sToZ <br />CONTRACTOR ADDRESS 37V6 /7/e CITY/STATE/ZIP <br />LICENSE E14-42 00C-36 OTHER NUMBER g/S3'o9 EXPIRATION DATE <br />6 2 5 'C" 7r/Afivcic. CITY/ZIP ZextZ.; <br />01SDS-DS1 <br />PHONE <br />JOB ADDRESS <br />CROSS STREET <br />OWNER NAME <br />PARCEL SIZE g 3 <br />NUMBER OF LIVING UNITS: <br />INSTALLATION WILL SERVE: K.RESIDENCE 0 COMMERCIAL C OTHER <br />NUMBER OF BEDROOMS: 4 NUMBER OF EMPLOYEES: <br />L. SEPTIC TANK TYPE/MFG /04Z- CAPACITY /eoo gal # OF COMPARTMENTS <br />GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS <br />DISTANCE TO NEAREST: WELL Jr-) ft FOUNDATION S ft PROPERTY LINE 57%) <br />LIFT STATION SIZE TYPE OF PUMP LI PKG TX PLANT CI SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />Final Inspection By Date E SPECIAL PERMIT - Approved by <br />Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br />COMMENTS Me vi • --rier tt Ak, vvelk v,):ftoo s 14246 p 1i b reccids <br />PE <br />Code <br />SC <br />INFO <br />Received <br />BY <br />Check#/ <br />Cash <br />Amount <br />Remitted Date Permit/ <br />Service Request # Invoice # Permit ID# <br />i...1 d 1 I 1(7 2375- --7 4,(:-F1 :2.10.10 S, 042-01(-1 <br />ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 42-01 <br />4/14/18 <br />A <br />LEACH LINES _ LEACHING CHAMBERS # OF LINES <br /> <br />LENGTH OF LINES 6 r ft <br />DISTANCE TO NEAREST WELL / 5-0 ft FOUNDATION <br /> 30 <br />ft PROPERTY LINE 5"0 ft <br />FILTER BED WIDTH ft LENGTH <br /> <br />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 />CI 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 3 WIDTH " <br /> <br />ft DEPTH ;;P2S"..... ft <br />DISTANCE TO NEAREST WELL /S-0 ft FOUNDATION ft PROPERTY LINE <br /> <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 />MINIMUM 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209)953-7697 <br />SIGNED/e. TITLE _z__•*--e...-•••00/je..-,e/e-x- DATE Z 10 ec? <br />11 <br />RECEIVE <br />SAN JOAQIJIN CDU NTY <br />ENVRON ENT* <br />HEALTH DE RTMPNTr. <br />DEPARTMENT USE ONLY <br />Application Accepted By Date /.)PC); Area 'I Or Employee ID*