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0 PERC TEST # <br />TYPE OF WORK: NEW INSTALLATION <br />REPLACEMENT <br />REPAIR/ADDITION <br />OUT-OF-SERVICE SEPTIC SYSTEM <br />L <br /> <br />ENGINEER DESIGNED /ALTERNATIVE <br />DESTRUCTION <br />BUILDING PERMIT # ckY5 u LAND USE APPLICATION # <br />EKEPTIC TANK <br />GREASE TRAP <br />LIFT STATION <br />TYPE/MFG <br /> P <br />TYPE/MFG <br />DISTANCE TO NEAREST: WELL I F30 I <br />SIZE TYPE OF PUMP PKG TX PLANT 0 SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />CAPACITY t••• gal # OF COMPARTMENTS D"... <br />CAPACITY gal # OF COMPARTMENTS <br />ft FOUNDATION 3S 1 <br />ft PROPERTY LINE S. ft <br />cce4„,( <br />7 Application Accepted <br />Final Inspection By <br />Area ,DA Employee ID# <br />Character of Soil to Depth of 3 F . <br />COMMENTS rill F P j r - <br />DEPARTMENT illSiE ONLY <br />Date ZP //,` I <br />Date -34 7/a0 2-1 <br /> Pit/Sump Soil Character: <br />CJ -C) vs) e ifs- < I:7; reCt--% rds, <br />PE <br />Code <br />SC <br />INFO <br />Received (Check#a Amount <br />Remitted Date Permit/ <br />Service Request # Invoice # Permit ID# Cash 1 <br />s?ti 310 _g.F.01.510 <br />ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />#44) <br />MA, <br />hP2 <br />AYR, .n47. <br />Ivo) <br />''202/ <br />1,111 <br />Jcl1n- <br />eiv <br />03,414,,..47-ry <br />0 SPECIAL PERMIT - Approved by <br />42-01 <br />4/14/18 <br />ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - SrockToN CA 95205 - (209) 468-3420 <br />NON-REFUNDABLE PERMIT CALL (209) 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />JOB ADDRESS ii 4)45- t. <br />)-01 CROSS STREET ffi 3t..s-E. APN 02.51 PARCEL SIZE <br />OWNER NAME L.; P PHONE <br />c <br />CONTRACTOR peyt 6,4,4(4 <br />CONTRACTOR ADDRESS p9 Any I. eg'G <br />LICENSE El EC-42 00C-36 OTHER NUMBER (3.dqs5.4 EXPIRATION DATE <br />WATER TABLE DEPTH: C,C) 0 <br /> <br />ft GEOGRAPHICAL INFORMATION: Coordinates X <br />OWNER ADDRESS ioei (mckco. <br />eit CITY/STATE/ZIP <br />PHONE <br />CITY/STATE/ZIP /1^ <br />,s,P-lb :SSMIGUY 31IS 40,4-ESIDENCE INSTALLATION WILL SERVE: <br />NUMBER OF LIVING UNITS: <br />COMMERCIAL <br />NUMBER OF BEDROOMS: 3 <br />11 OTHER <br />NUMBER OF EMPLOYEES: <br />12".11-EACH LINES H LEACHING CHAMBERS # OF LINES LENGTH OF LINES %z)i <br />DISTANCE TO NEAREST WELL 4 00 ; ft FOUNDATION . <br />6„-.1 <br />ft PROPERTY LINE <br />FILTER BED WIDTH ft LENGTH ft DEPTH <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE <br />MOUNDED WIDTH ft LENGTH ft DEPTH <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE <br />SUMPS WIDTH ft LENGTH ft DEPTH <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE <br />DISPOSAL PONDS WIDTH ft LENGTH <br /> <br />DEPTH <br />DISTANCE TO NEAREST WELL <br />le.....;EPAGE PITS NUMBER <br />DISTANCE TO NEAREST WELL <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 />ft FOUNDATION <br />is-01 ft FOUNDATION <br />WIDTH ft <br />ft PROPERTY LINE <br />DEPTH <br />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 Con /1ce-m. DATE _3 I )41