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EXPIRES 1 YEAR FROM DATE ISSUED <br />PARCEL SIZE S 0 C. APN ObOrc0/7 <br />NUMBER sns LICENSE EC-42 KDC-36 OTHER <br />CITY/STATE/ZIP <br />PHONE <br />c. (15.137 <br />Tz.-2) o <br />CITY/STATE/ZIP VtArik7e ca. Ca. SS-3U <br />EXPIRATION DATE 0 CA' 102 <br />4 <br />OE 1 <br />42-01 <br />3,10 4/14/18 <br />ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAzELToN AVENUE - STockToN CA 95205 -(209) 468-3420 <br />OWNER NAME <br />OWNER ADDRESS 1-1,, 7 Or (J!ktr ç ,cel <br />CONTRACTOR 13 Pt-U A411 n <br />CONTRACTOR ADDRESS 67-a-i,A oho cic <br />PHONE 2o9- .499 -54i 3 <br />CROSS STREET •Pf-P r h C_CP-AY-1. <br />F a kCire_eD :SS311WEIV 3,LIS 0 <br />0 <br />SEPTIC TANK <br />GREASE TRAP <br />LIFT STATION <br />TYPE/MFG P + <br />TYPE/MFG <br />DISTANCE TO NEAREST: <br />SIZE TYPE <br />WELL <br />OF PUMP <br />0 LEACH LINES I LEACHING CHAMBERS <br />DISTANCE TO NEAREST WELL <br />14 FILTER BED WIDTH 20 ft LENGTH <br />DISTANCE TO NEAREST WELL <br />0 MOUNDED WIDTH ft LENGTH <br />DISTANCE TO NEAREST WELL <br />0 SUMPS WIDTH ft LENGTH <br />DISTANCE TO NEAREST WELL <br />0 DISPOSAL PONDS WIDTH ft LENGTH <br />DISTANCE TO NEAREST WELL <br />0 SEEPAGE PITS NUMBER WIDTH <br />DISTANCE TO NEAREST WELL <br />ft PROPERTY LINE <br />ft DEPTH <br />ft DEPTH ft <br />ft <br />ft <br />ft FOUNDATION ft PROPERTY LINE ft <br /> ft PROPERTY LINE ft ft FOUNDATION <br />Z.' ft <br />gal # OF COMPARTMENTS <br />gal # OF COMPARTMENTS <br />ft PROPERTY LINE <br />El SAND OIL SEPARATOR (ENCLOSED SYSTEM) PKG TX PLANT <br />CAPACITY (2.00 <br />LENGTH OF LINES ft <br />FOUNDATION ft PROPERTY LINE ft <br />ft 4 <br />ft FOUNDATION Ao' ft PROPERTY LINE 1 7 ft <br />ft DEPTH ft <br /># OF LINES <br />ft <br />ft DEPTH 42, <br />ft DEPTH ft <br />ft FOUNDATION ft PROPERTY LINE ft <br />ft FOUNDATION <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 />2020 <br />N <br />Nita <br />Til OEPARENT <br />Area 31cfri Employee I r <br />Date 0 SPECIAL PERMIT -Approved by <br />Pit/Sump Soil Character: <br />v4ets 6: icri c-ina tr7tix he; vr j;eeii <br />4 P, pro iqf <br />, 011P ST ./12e4(kIS pffr (06' ferOirlS1 <br />SIGNED t--/A,r.iiA <br />UM 48 HOUR ,AD NOTICE REQUIRED FOR IMPECTIONS - PLEASE CALL (209)953-7697 <br />TITLEV..MC_ •P' Ltnb DATE ? (-2O 2O <br />Final Inspection By <br />Character of Soil to Depth of 3 Ft: <br />COMMENTS We9i4k:i>5 eo <br />clowieljed when pui-1-15 <br />DEPARTMENT U ISE ONLY <br />Application Accepted By Date <br />20A <br />Itiesys-lrfro , 5,s-tervi <br />in -frees- 'rip( <br />PE <br />Code <br />SC <br />INFO <br />ttece#ed <br />"— <br />Check#/ <br />Cash Cash <br />Amount <br />Remitted Date Permit/ <br />Request # Invoice # Permit ID#Service <br />93 1D 1 i c V1r,6\4i 'F-. OD 121/1124 12e(R-30(17 <br />NON-REFUNDABLE PERMIT CALL (209) 953-7697 FOR INSPECTIONS <br />JOB ADDRESS \440 Auttkin te0 CITY/ZIP 04..kt,.:. <br />ENT <br />veD <br />PA <br />NEW INSTALLATION <br />REPLACEMENT 1-011k- ci <br />REPAIR/ADDITION <br />OUT-OF-SERVICE SEPTIC SYSTEM <br />Li ENGINEER DESIGNED /ALTERNATIVE <br />A' DESTRUCTION i-61 11 i< <br />TYPE OF WORK: <br />WATER TABLE DEPTH: —6 ° <br />PERC TEST # <br />ft GEOGRAPHICAL INFORMATION: Coordinates X <br /> <br />INSTALLATION WILL SERVE: RESIDENCE <br /> <br />COMMERCIAL <br /> 0 OTHER <br /> <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br />BUILDING PERMIT # <br /> <br />LAND USE APPLICATION #