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DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE <br />SEEPAGE PITS NUMBER 3 WIDTH ft DEPTH Ca? <br />DISTANCE TO NEAREST WELL I 2-C...) ft FOUNDATION 7 0 CT ft PROPERTY LINE <br />Area Employee ID# <br />I 20b 14C0 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 />NON-REFUNDABLE PERMIT CALL (209) 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />b ci N 1, a ) <br />f\v,i APN I CI ) ()0,.`?, <br />8- /2_ I /0 1/0a../ s <br />CONTRACTOR 5 el:34-i L Serpi. ces 6 izotcp <br />CONTRACTOR ADDRESS Fff, 75 e) x 5-69 <br />LICENSE . C-42 : C-36 OTHER <br />WATER TABLE DEPTH: 0 = DO ft GEOGRAPHICAL INFORMATION: Coordinates X <br />CAPACITY <br />CAPACITY <br />FOUNDATION <br />12 00 <br />gal # OF COMPARTMENTS <br />ft PROPERTY LINE ft <br />gal # OF COMPARTMENTS <br />SIZE TYPE OF PUMP LI PKG TX PLANT 0 SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />TYPE/MFG <br />TYPE/MFG <br />DISTANCE TO NEAREST: WELL /,ft <br />r PERC TEST # <br />TYPE OF WORK: <br />INSTALLATION WILL SERVE: IX RESIDENCE COMMERCIAL / I OTHER <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: 3 LC'(,1,1" NUMBER OF EMPLOYEES: <br />NEW INSTALLATION <br />REPLACEMENT <br />BUILDING PERMIT # <br />REPAIR/ADDITION ENGINEER DESIGNED /ALTERNATIVE , <br />OUT-OF-SERVICE SEPTIC SYSTEM / DESTRUCTION +eil Ici fec4 <br />- 0 SEPTIC TANK <br />GREASE TRAP <br />LIFT STATION <br />LAND USE APPLICATION # <br />JOB ADDRESS <br />CROSS STREET <br />OWNER NAME <br />PARCEL SIZE <br />PHONE 6 56 -1-fel 0 -5Z <br />OWNER ADDRESS 1t'39 N At p fall CITY/STATE/ZIP 4-0 /11:172, rt. /c/c3 <br />PHONE <br />CITY/STATE/ZIP 14-00%) GA 95693 <br />NUMBER 106 Kota .....,.PIRATiON DATE g `..*:g Z:t <br />iry, k3 <br />Alpine <br />DISTANCE TO NEAREST WELL <br />FILTER BED WIDTH ft LENGTH <br />DISTANCE TO NEAREST WELL <br />MOUNDED WIDTH ft LENGTH <br />DISTANCE TO NEAREST WELL <br />SUMPS WIDTH ft LENGTH <br />DISTANCE TO NEAREST WELL <br />DISPOSAL PONDS WIDTH ft LENGTH <br />ft FOUNDATION /00 IL ft <br />ft <br />ft FOUNDATION ft PROPERTY UNE ft <br /> ft DEPTH ft <br />ft FOUNDATION ft PROPERTY LINE ft <br /> ft DEPTH ft <br />ft FOUNDATION ft PROPERTY LINE ft <br /> ft DEPTH ft <br />LEACH LINES LEACHING CHAMBERS # OF LINES 6 <br />70 <br />I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPUCATION 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 4 Co R DVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209)953-7697 <br />SIGNED TITLE g L-= DATE <br />PE <br />Code <br />. , i , • <br />SC <br />INFO <br />Received <br />By <br />Check#1 <br />Qash <br />Amount <br />Remitted Date Permit/ <br />Service Re3uest # Invoice # Permit ID# <br />dRIO HS- Vi de54 4'300 '1 .IM II (3 IZ 00g 350 I <br /> ft <br />ft <br />/ ft <br />S <br />LENGTH OF LINES ft <br />PROPERTY <br />ft <br />PROPERTY LINE / 0 ft <br />DEPTH ft <br />42-01 <br />4/14/18 <br />c r ts .7 (if (74/,!:. I s -to j1fj. SC(,00 1,y sf .v #11 fe.i 4 /7f.C/ <br />11 Niel; <br />DEPARTMENT USE ONLY <br />Application Accepted By Date a_./ Arf <br />Final Inspection By Date 12L4 -Z SPECIAL PERMIT - Approved by <br />Character of Soil to Depth of 3 Ft: I6luSudip Soil Character: <br />COMMENTS X )....st ir.3 Sy s -1 e ori fjsfiri 13 Fe. :e 5)(0.6 <br />I4 <br /> 44 Aa <br />ki5)/ <br />202 <br />DA <br /> <br /> <br />4, 044A, p 4ou,vry <br />'417414417- <br />/4 1