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INSTALLATION WILL SERVE: <br />NUMBER OF LIVING UNITS: <br />VIESIDENCE E COMMERCIAL <br />E OTHER <br />NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br />LENGTH OF LINES <br />ft PROPERTY LINE <br />DEPTH <br /># OF LINES <br />ft FOUNDATION FOUNDATION 10 <br />ft <br />ss- <br />5 <br />!A 06 <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 />JOB ADDRESS I A ; inc <br />CROSS STREET Sk,-(4- Pa <br />0 3 Ei ,€ly 1,4 e 11 r• <br />78111 Pi pder 1Vl r <br />cingzip ;C•41ai1 j c::4 <br />OWNER NAME <br />OWNER ADDRESS <br />APN PARCEL SIZE <br />PHONE <br />CITY/STATE/ZIP 1:2 Sco ())1 q c-3 :SS32111(11; 31.1S CONTRACTOR <br />CONTRACTOR ADDRESS <br />LICENSE EC-42 El 0C-36 OTHER A. <br />i/y) i4.-_.444 .e r. <br />&;‹ 6,S-6 <br />NUMBER <br />PHONE <br />CITY/STATE/ZIP MC 4tiade-4/4 (Z4 95-33 <br />EXPIRATION DATE 4 3 i <br />WATER TABLE DEPTH: <br />E PERC TEST # <br />TYPE OF WORK: ---7..NEW INSTALLATION <br />REPLACEMENT <br />ft GEOGRAPHICAL INFORMATION: Coordinates X <br />BUILDING PERMIT # I CO (Pei LAND USE APPLICATION # <br />REPAIR/ADDITION <br />OUT-OF-SERVICE SEPTIC SYSTEM <br />LI ENGINEER DESIGNED /ALTERNATIVE <br />El DESTRUCTION <br />CV-SEPTIC TANK TYPE/MFG <br />GREASE TRAP TYPE/MFG <br />DISTANCE TO NEAREST: WELL <br />LIFT STATION SIZE <br />CAPACITY 1).0o gal # OF COMPARTMENTS a <br /> CAPACITY gal # OF COMPARTMENTS <br />I <br />ft FOUNDATION 51 <br />ft PROPERTY LINE 40' <br />ft <br /> TYPE OF PUMP U PKG TX PLANT 0 SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />13,./CE-ACH LINES <br />LEACHING CHAMBERS <br />DISTANCE TO NEAREST WELL tW)' <br />FILTER BED <br /> <br />WIDTH <br /> <br />ft LENGTH <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE <br />MOUNDED <br /> <br />WIDTH <br /> <br />ft LENGTH ft DEPTH <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE <br />SUMPS <br /> <br />WIDTH <br /> <br />ft LENGTH <br />ft DEPTH <br />DISTANCE TO NEAREST WELL ft FOUNDATION <br />ft PROPERTY LINE <br />DISPOSAL PONDS WIDTH <br /> <br />ft LENGTH ft <br /> <br />DEPTH <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION ft PROPERTY LINE <br />SEEPAGE PITS NUMBER WIDTH <br />ft DEPTH <br />DISTANCE TO NEAREST WELL t ft FOUNDATION 10 1 <br />ft PROPERTY LINE -10 I <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 A VANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209)953-7697 <br />SIGNED TITLE (..-'0)1 DATE I 6 d. <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 />e.- ti4 Le—oi <br />TY <br />------:-.Z- <br />DEPARTMENT/ U E ONLY ENVIRONMENT I) (- <br />Date i/ 627 / Area 9 / q q HEtitipoKporr Tit _. <br />Date \ , 1 `-• 7.. 1 E SPECIAL PERMIT - Approved by <br />Character of Soil to Depth of 3 Ft: Fit/Sump Soil Character: <br />COMMENTS /446- Ah914 f; Pk., SeCord (Ji if. i i er Z. Ho iLs 14 / nifyi setkicks per <br />Poo (7 records, <br />PE <br />Code <br />SC <br />INFO <br />Received <br />By <br />qheck#/ <br />Cash <br />Amount <br />Remitted Date Permit/ <br />Service Request # Invoice # Permit ID# <br />L4 1 3 117 (14020 /nt)(97C 'S1 sV • 21 W 01A3111-1 <br />v <br />42-01 <br />ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />SAN JOAQUIN • <br />Application Accepted By <br />Final Inspection By <br />4/14/18