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JOB ADDRESS 17,-; <br />CROSS STREET (in e r ke e. <br />OWNER NAME ^ •-" <br />OWNER ADDRESs ,) <br />A-1- CITY/ZIP - <br />0g'-7 bq 06S <br />PHONE <br />rs' CITY/ S TATE/ZIP <br />PARCEL SIZE / 50 <br />1`% =rly <br />S z)Th <br />APN <br />r <br />CONTRACTOR PHONE <br />CONTRACTOR ADDRESS CITY/STATE/ZIP <br />LICENSE DiDC-42 0 DC-36 OTHER <br />NUMBER <br /> <br />EXPIRATION DATE <br />WATER TABLE DEPTH: <br />GEOGRAPHICAL INFoRMADON: Coordinates X <br />0 PERC TEST # <br /> <br />BUILDING PERMIT # <br /> <br />LAND USE APPLICATION # PA -1;20 00 iq <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 />C. ENGINEER DESIGNED /ALTERNATIVE <br />0 OTHER <br />NUMBER OF EMPLOYEES: <br />gal # OF COMPARTMENTS <br />gal # OF COMPARTMENTS <br />ft PROPERTY LINE ft <br />SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />LENGTH OF LINES ft <br />ft PROPERTY LINE ft <br />DEPTH ft <br />ft PROPERTY LINE ft <br />DEPTH ft <br />ft PROPERTY LINE ft <br />DEPTH ft <br />ft PROPERTY LINE ft <br />DEPTH ft <br />ft PROPERTY LINE ft <br />ft DEPTH ft <br />ft PROPERTY LINE ft <br />DESTRUCTION S.0.' F IC te111 :SSRICUIV 31IS TYPE OF WORK: NEW INSTALLATION <br />L REPLACEMENT <br />REPAIR/ADDITION <br />0 OUT-OF-SERVICE SEPTIC SYSTEM <br />INSTALLATION WILL SERVE: 0 RESIDENCE <br />NUMBER OF LIVING UNITS: <br />0 COMMERCIAL <br />NUMBER OF BEDROOMS: <br />ID <br />D <br />ID <br />SEPTIC TANK <br />GREASE TRAP <br />LIFT STATION <br />TYPE/MFG CAPACITY <br />TYPE/MFG CAPACITY <br />DISTANCE TO NEAREST: <br />SIZE TYPE <br />WELL ft FOUNDATION <br />OF PUMP 0 PKG TX PLANT ID <br />0 LEACH LINES 0 LEACHING CHAMBERS <br />DISTANCE TO NEAREST <br /># OF LINES <br />WELL ft FOUNDATION <br />U FILTER BED WIDTH ft LENGTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION <br />0 MOUNDED WIDTH ft LENGTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION <br />U SUMPS WIDTH ft LENGTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION <br />U DISPOSAL PONDS WIDTH ft LENGTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION <br />0 SEEPAGE PITS NUMBER WIDTH <br />DISTANCE TO NEAREST WELL ft FOUNDATION <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 />SIGNED TITLE ./t/ /- r DATE -r: — 4 51 <br />MINIMUM 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPEC TIONS - PLEASE CALL (209)953-7697 <br /> movr E`c <br />sAN J <br />EAI /113-al CotiNry 1.41 EivrAL <br />FEBI VEC) <br />aj, 2021 <br />Application Accepted By Date 4); 0 Area Employee ID# NEV. <br />Final Inspection By Date S 0 SPECIAL PERMIT - Approved by <br />Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br />COMMENTS R 1 4l1e ciew)-01kiier viiide et 011 ror P0,101,-0 <br />PE <br />Code <br />SC <br />INFO <br />Received <br />B <br />Amount <br />Remitted Date Permit/ <br />Se rvice quest # Invoice # Permit ID# <br />14 d)d 0-- 1 7S • i '. 'ik i S. c <br />912.4 s <br />1-?,08t <br />42-01 <br /> ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4/14/18 <br />1 4 C'J C/1 <br />DEPARTMENT US ONLY (