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E PERC TEST # TYPE OF WORK: BUILDING PERMIT # LAND USE APPLICATION # REPAIR/ADDMON OUT-OF-SERVICE SEPTIC SYSTEM NEW INSTALLATION REPLACEMENT ENGINEER DESIGNED /ALTERNATIVE DESTRUCTION ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 -(209) 468-3420 NON-REFUNDABLE PERMIT CALL (209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED :SS3110:1(1V 3.LIS a crryizip La4 i cf ,s- zeit to; CROSS STREET •,5*(11C- ie:- or 1 e. APN 005L9 (P GI OR PARCEL SIZE SY q 7 OWNER NAME aa. a fl .7:21-1 a PH OWNER ADDRESS ) 07/3 9 .3-141e_.s. gel., L-11 CITY/STATE/Zip g4"--;k--1.11-1 9 S d 0 el CONTRACTOR Er 11 . )_12t 21 Les ---//26.,e PHONE ?J& —36C-, -- III i CONTRACTOR ADDRESS Fe) G,--:,>,..., ,.--6'• ciTyisTATEIzip 1,0 , 1 4-6,-,4 GA LICENSE I I C-42 I C-36 OTHER \ A' NUMBER /D45? ZCP)EXPIRATION DATE .0 -31 —Z-CD Z.Z.. JOB ADDRESS PHONE Z (r) cr WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X INSTALLATION WILL SERVE: IX RESIDENCE I COMMERCIAL I OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ft FOUNDATION LI PKG TX PLANT CAPACITY gal # OF COMPARTMENTS ft PROPERTY LINE ft ft ft ft ft ft ft ft ft ft ft ft ft LIFT STATION SIZE TYPE OF PUMP )5i SEPTIC TANK TYPE/MFG GREASE TRAP TYPE/MFG DISTANCE TO NEAREST: WELL LEACH LINES LEACHING CHAMBERS DISTANCE TO NEAREST FILTER BED WIDTH DISTANCE TO NEAREST MOUNDED WIDTH DISTANCE TO NEAREST SUMPS WIDTH DISTANCE TO NEAREST DISPOSAL PONDS Worn DISTANCE TO NEAREST X SEEPAGE PITS NUMBER DISTANCE TO NEAREST 0 SAND OIL SEPARATOR (ENCLOSED SYSTEM) # OF LINES I LENGTH OF LINES CAPACITY I 0 gal # OF COMPARTMENTS Z- WELLJO -. ft FOUNDATION 1.17(") ft PROPERTY LINE I () ft LENGTH ft DEPTH WELL ft FOUNDATION # PROPERTY LINE ft LENGTH ft DEPTH WELL ft FOUNDATION # PROPERTY LINE # LENGTH ft DEPTH WELL ft FOUNDATION ft PROPERTY LINE ft LENGTH ft DEPTH WELL ft FOUNDATION ft PROPERTY LINE WIDTH ft DEPTH 2. WELL A."1-0,4- ft FOUNDATION C> "/"" # PROPERTY LINE I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY CADINANCES, STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. MINIMUM SIGNED 48 OU ADVANCE NOTICE REQUIRED FOR INSP TIONS - PLEASE CALL (209)953-7697 TITLE DATE 2— 1---- K )te-C ZI ear 1 DEPARTMENT U E ONLY Date di t2 Area 11 /g GI Employee ID# Date"2- 4/2.7,1 SPECIAL PERMIT -Approved by Pit/Sump Soil Character: )hie.s -to remelin. PE Code SC SC INFO Received Check#/ Amount Remitted Date _ Permit/ Service Request # Invoice # Permit ID# LI i is- Cash aio (19 eied;-,- +300 -/-71 / ,504)32.23 42-01 4/14/18 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT Application Accepted By Final Inspection By Character of Soil to Depth of 3 Ft: / COMMENTS Fc1 / 11 n_5 f7 1 -Lc p retordS_