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PHONE <br />CITY/STATE/ZIP <br />CONTRACTOR 6444w/ 114 cce/li'c <br />CONTRACTOR ADDRESS 37'116 Mee- a <br />PHONE <br /> <br />— Gfr' 7 <br />CITY/STATE/ZIP ,-5/Ct:111 , ('.4 4s-3f9 <br />per , C OTHER <br />0 NUMBER OF EMPLOYEES: <br />At4R 0 5 <br />2021 <br />OW N filtPRtnA, COuN 6"6,1 ,441V TAL, <br />NEAT <br />8,AN <br />44. JcIA <br />DEPARTMENT USE ONLY <br />Date <br />Date <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 />JOB ADDRESS 7 A) • • ' -€40/ CITY/ZIP <br />CROSS STREET afire) Poet/ <br />OWNER NAME x/ 7, Z‘z; C. <br />OWNER ADDRESS a 3a o Pc e <br />APN <br /> 7,9 (-,33e <br />PARCEL SIZE 1 :SS:11101V 311S LICENSE 0)6-42 EIL1C-36 OTHER <br />WATER TABLE DEPTH: ft <br />-- NUMBER VS 4/S —9° EXPIRATION DATE <br />GEOGRAPHICAL INFORMATION: Coordinates X <br />LI PERC TEST # BUILDING PERMIT # <br /> <br />LAND USE APPLICATION # <br />E COMMERCIAL <br />NUMBER OF BEDROOMS: <br />.21( SEPTIC TANK <br />la GREASE TRAP <br />LIFT STATION <br />TYPE/MFG 600Ctliefrj <br />TYPE/MFG <br />DISTANCE TO NEAREST: WELL /4X/ <br />SIZE TYPE OF PUMP <br />CAPACITY /AOC. gal # OF COMPARTMENTS <br />CAPACITY gal # OF COMPARTMENTS <br />ft <br /> <br />PROPERTY LINE .30 ft <br />PKG TX PLANT 0 SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />TYPE OF WORK: 11 NEW INSTALLATION <br />)(' REPLACVIENT <br />INSTALLATION WILL SERVE: RESIDENCE <br />NUMBER OF LIVING UNITS: <br />L REPAIR/ADDITION <br />OUT-OF-SERVICE SEPTIC SYSTEM IP <br />LI ENGINEER DESIGNED /ALTERNATIVE <br />DESTRUCTION my' k <br />ft FOUNDATION <br />Li LEACH LINES <br /> <br />LEACHING CHAMBERS # OF LINES <br /> <br />LENGTH OF LINES <br />DISTANCE TO NEAREST WELL <br /> <br />ft FOUNDATION <br /> <br />ft PROPERTY LINE <br />FILTER BED WIDTH ft LENGTH <br /> <br />ft DEPTH <br />DISTANCE TO NEAREST WELL <br /> <br />ft FOUNDATION <br /> <br />ft PROPERTY LINE <br />MOUNDED <br /> WIDTH ft LENGTH <br /> <br />ft DEPTH <br />DISTANCE TO NEAREST WELL <br /> <br />ft FOUNDATION ft PROPERTY LINE <br />LI SUMPS <br /> <br />WIDTH ft LENGTH <br /> <br />ft DEPTH <br />DISTANCE TO NEAREST WELL <br /> <br />ft FOUNDATION ft PROPERTY LINE <br />DISPOSAL PONDS WIDTH ft LENGTH <br /> <br />ft DEPTH <br />DISTANCE TO NEAREST WELL <br /> <br />ft FOUNDATION ft PROPERTY LINE <br />Ci SEEPAGE PITS NUMBER WIDTH <br /> <br />ft DEPTH <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 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209)953-7697 <br />SIGNED TITLE_4212 DATE 3 — ?/c <br />ft <br />ft <br />ft <br />ft <br />ft <br />ft <br />ft <br />ft <br />ft <br />ft <br />ft <br />ft <br />YlifeArr. - Aeto <br />Application Accepted <br />Final Inspection By <br />Character of Soil to Depth of 3 Ft: <br />COMMENTS f2 ep6.,eln <br />WM IA- <br />of <br />110 Ur-6-0 #1 <br />Area V67ci Employee ID# <br />SPECIAL PERMIT - Approved by <br />Pit/Sump Soil Charffter: <br />160,_tIi?)'y1t1fl <br />re- 4,41.01-- <br />ek <br />0 <br />/ 1/ <br />PE SC Received heck#/ Amount <br />Code INFO B Remitted Service Request # Date Permit/ Invoice # Permit ID# <br />Li061 I lc 2-1119 4.300 3 "19-i s`c2-00933()(1 <br />... <br />42-01 <br /> <br />-OKSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4/14/18