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CITYISTATEMP OWNER ADORESS Rine" <br />Joe Amens V- 3 Lke a ; °ryas. C Lenl <br />Cross STREET HWY Sd. APN 021- 20- 6 PaaceL Sas 24 <br />ft on...) <br />Peons OWNER NAME <br />CONTRACTORJ-5 C (1):)--r r-u cerg., i1n. Nora I ' 2-7 <br />CoranAcToit ADORES.% ..777 1770/ZTe V,,„, 4 t.".4, 6C, Orr/Sum/2n Stl‘,-.,„,,e. 44 ,1 9s-"E' F <br />LICENSE l/‘-42 C-36 OTHER NUMBER T Z y sL., EXPIRATION DATE C>C• /f <br /> <br />FouNDATON 2: • ft PROPERTY LiNE 3net ft <br />ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1663 E. HAZELTON AVENUE • STOCKTON CA 95205 • (208)468-3020 <br />NON-REFUNDABLE PERMIT CALL (209)953-7697 FOR haPEcnoNs EXPIRES 1 YEAR FROM DATE ISSUED <br />WATER TABLE DEPTH: <br /> <br />GEOGRAPHICAL INFORMATION: Coordinates X <br /> <br />BUILDING PERMIT # LAND USE APPUCATiON # PERC TEST if <br /> <br />TYPE OF WORK: NEW INSTALLATKIN I REPAIRIADOTTION ENGINEER DESIGNED IALTERNATNE <br />V REPLACEMENT <br /> <br />OUT-OF-SERVICE Some SYSTEM DESTRUCTION <br /> <br />INSTALLATION WILL SERVE: iv-I/novice COMMERCIAL OTHER <br /> <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: <br /> <br />NUMBER OF EMPLOYEES: <br />SEPTIC TANK T/Ntrc, _ CAPACITY gal 14 CP COMPAPTMEnTs <br />GREASE TRAP T-.E./61=3 CAPACITY gal HOP COMPARTMENTS <br />DISTANCE TO NEAREST: WE..t. ft FOUNDATION ft PROPERTY LINE ft <br />UFT STATION SIZE TYPE OF PUMP 0 PKG TX PLANT 0 SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />1 <br />OVLEACH UNES LEACHING CHAMBERS e 01 1 CC litarr il cF LINES 3 LENGTH OF LINES . Sy 'ft <br />DISTANCE TO NEAREST , WELL / CZ) ' 0" ft <br />FILTER BED WIDTH ' ft LENGTH ft DEPTH <br />DISTANCE TO NEAREST WELL ft FOUNDAT,'ON ft PR'OPERTT LNE R <br />MOUNDED WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREAT i WEAL ft rOUNOATtON ft PROPERTY LINE ft <br />I( SUMPS WDTH f , _ 12N n OTH 1 CP 1 ft DEPTH 16 ft <br />DISTANCE TO AREET *La :ZE,C1 4- ft FOUICATION 20' -1.- ft PROPERTY LINE 3r, (1 ' .f ft <br />DISPOSAL PONDS Worn ft LENGTH ft DEPTH f1 <br />DISTANCE TO NEAREST TEAL ft FOUNDATION ft PROPERTY LINE ft <br />SEEPAGE PITS NUMBER W1D7 II ft DEPTH ft <br />DISTANCE TO NEAREST WE_ L ft rou..IDArics.,, ft PROPERTY LINE ft <br />0 ,A e.: V A u I'S -7 (4. ,. il • <br />_ l' C <br />, a r 7 P A <br />Q i1 5" Ti c I, <br />I i Li I <br />1 <br />ir. • ,ura <br />-?-/I;E-c...• <br />/ NO/ Application Accepted B ...if -I. Y,.. <br />. <br />Date <br />, <br />4.111116.P.MY Area Employee IDN Ilwrir4•.nrmik--„, Final Inspection By ,...1 —. -iiisraP.P.:. i _ Date Tli 2. 0 - SPECIAL PERMIT . Appfoved by <br />Character of Soil to Depth of 3 Ft: PH/Sump Soil Character: <br />COMMENTS <br />PE <br />Cod. <br />SC <br />INFO <br />Received 7 Ch•cldr/ <br />Cash <br />Amount <br />'Remitted Date Permit/ <br />Service R Lunt N Invoice 0 Permit ION 4zpf- 1 IS .16- deefb•--t 43(soi g\-ti sc <br />ft <br />: HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAOUIN COUNTY ORENHANCES,P <br />STATE LAWS AND RULES AND REGULATIONS OF SAN JOAOUIN COUNTY. <br />ON ouiv <br />4/16N r <br />7'41 r- N 2- <br />AgN 1,,m q HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (2091953-7697 <br />SIGNED TITLE Pr ris.4 DATE C' 3/0/20:- '711R 0 <br />202/ <br />42-01 <br />4t4lft ONSITE WASTEWATER TRTANT SYSTEM PERMIT