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NUMBER 1C909CE;CPIRATION DATE LICENSE D(42 0 =C-36 OTHER 0 PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # REPAIR/ADDMON ENGINEER DESIGNED /ALTERNATIVE DESTRUCTION REPLACEMENT 0 OUT-OF-SERVICE SEPTIC SYSTEM NEW INSTALLATION TYPE OF WORK: D OTHER NUMBER OF EMPLOYEES: INSTALLATION WILL SERVE: KRESIDENCE 0 COMMERCIAL NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: 3 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 WATER TABLE DEPTH: less rilt!ii 10 ft GEOGRAPHICAL INFORMATION: Coordinates X JOB ADDRESS al 44 5 0/(40der- CITY/ZIP 114144-rt4 (24-- CROSS STREET APN 96D4.101 ) PARCEL SIZE • cit OWNER NAME Aliqf ddk PHONE 47/.4 8147 - /f711 CITY/STATE/ZIP CONTRACTOR C;41.44f'q Ve// Sr1911,./J,C PHONE do 9 - 3ce 50.27 ft cirdsTATEizip 54,e av ,41 OWNER ADDRESS CONTRACTOR ADDRESS ? eke SEPTIC TANK TYPE/MFG CT/447 Lif GREASE TRAP TYPE/MFG DISTANCE TO NEAREST: WELL ft FOUNDATION LI LIFT STATION SIZE TYPE OF PUMP LI PKG TX PLANT 0 SAND OIL SEPARATOR (ENCLOSED SYSTEM) LI LEACH LINES 0 LEACHING CHAMBERS # OF LINES LENGTH OF LINES ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft X FILTER BED WIDTH / 0 / ft LENGTH cpy • ft DEPTH I8' a--4.4 ft DISTANCE TO NEAREST WELL ft FOUNDATION /0 ft PROPERTY UNE A.... " ft CI MOUNDED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY UNE ft SUMPS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY UNE ft DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY UNE ft SEEPAGE PITS NUMBER WIDTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPUCATION AND THE WORK WILL BE DONE IN ACCORDANCE VviTH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. MINIMUM 48 HOUR ADVANCE NO ICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 SIGNED TITLE of DATE 2 - CAPACITY CAPACITY gal # OF COMPARTMENTS gal # OF COMPARTMENTS F PROPERTY LINE ft ft :SSMICKIViJS 91-0t/7-cd DEPARTMENT SE ONLY Application Accepte Date a Vol / Area Sig Employee ID# Final Inspection By Date II 2 k 0 SPECIAL PERMIT -Approved by Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS 5pirtvl SloW okrin - *Jure. 1-_71xishhj sy5 -19111 _6,4.1_1707j' Oies tb PE Code SC INFO Received Che . Amount Remitted Date Permit/ Service Request # Invoice # Permit ID# 14210 1 lg. di). _ /67 ,_3(z) *5/2/ 5R00 13 3.2 4 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18