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DEPARTMENT s A ONLY I <br />Date a ff1,21 Area ilig/- Emplo <br />Date LI gly2.02,1 0 SPECIAL PERMIT - Appro <br />Pit/Sumo Soil Character <br />?"-4---7 <br />Application Accepted <br />Final Inspection By <br />Character of Soil to De <br />COMMENTS <br />ite?. <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)963-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />JOB ADDREE _ _ . / e 2 aD E. ...) eithINT / 1 cn-yal p Attortii PO ¶r3-2-0 NI . "Dv STiN.1 <br />CROSS STREET 'DUST") APN oetn - bre- - . . PARCEL SIZE I by At. <br />OWNER NAME Set< CI LEVE.P.IT it.) 1 p fitrU 9/ fitger:r1 clo C &Ili t 1-1.4a_ PHONE .414 •4fli 0 I <br />LEV E. &IT I N I <br />CONTRACTOR LIVE' orme_ c.7z0ENVIRONvytenn-A L PHONE 361- o3-1 <br /> <br />CONTRACTOR ADDRESS 1401 c...)• CA-te- Sr. CITY/STATE/ZIP LAD t Get cir 2-44 0 <br />LICENSE 00C-42 00C-36 OTHER ce& NUMBER <br /> <br />EXPIRATION DATE 4- 3o- 2-2.. <br /> <br />OWNER ADDRESS P.O Svat CITY/STATE/ZIP Acfnm,Po CA <br />WATER TABLE DEPTH: <br /> <br />ft GEOGRAPHICAL INFORMATION: Coordinates X <br /> <br />PERC TEST <br />TYPE OF WORK: 0 NEW INSTALLATION <br />REPLACEMENT <br />REPAIR/ADDITION <br />OUT-OF-SERVICE SEPTIC SYSTEM <br />ENGINEER DESIGNED /ALTERNATIVE <br />DESTRUCTION <br />BUILDING PERMIT # <br /> <br />LAND USE APPLICATION # <br /> <br />INSTALLATION WILL SERVE: 0 RESIDENCE <br /> <br />0 COMMERCIAL <br /> <br />0 OTHER <br /> <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: <br />NUMBER OF EMPLOYEES: <br />SEPTIC TANK <br />GREASE TRAP <br />DISTANCE TO NEAREST: WELL <br />LIFT STATION SIZE TYPE OF PUMP <br />TYPE/MFG <br />CAPACITY <br />TYPE/MFG <br />CAPACITY <br />ft FOUNDATION <br /> 0 PKG TX PLANT <br /> gal # OF COMPARTMENTS <br /> gal # OF COMPARTMENTS <br />ft PROPERTY LINE ft <br />0 SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />LEACH LINES I LEACHING CHAMBERS <br /># OF LINES LENGTH OF LINES ft <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION ft PROPERTY LINE ft <br />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 ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY UNE ft <br />SUMPS WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION <br />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 WIDTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE <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 UR ADVCE NOTICE REQUIRED FOB INSPECTIONS - PLEASE CALL (209)953-7697 <br />SIGNED fcT TITLE IPACU • 141 • DATE 2.. - ?-I <br />ft <br />• _ -, : <br />li <br />4 Iit i p•- g 2 <br />i i <br />... <br />i <br />I 1 <br />I 1 I 1 <br />1 i 11 z' <br />II I 41 It /i` <br />i \ <br />a n <br /> i l / 4I4$; <br />-, <br />8.11 ° fn., <br />r 1 1 I - 2. .._ —1, <br />PE <br />Code <br />SC <br />INFO <br />Received <br />B <br />ekwjfah, <br />Cash <br />Amount <br />Remitted Date Permit/ <br />Service Request # Invoice # Permit ID# <br />tpaa SA3 ReCte2 4it till S12004S262 <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18