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JOB ADDRESS 25 2:51 TL/V-lf (ran Root <br />CROSS STREET 0...4) 11 ier Read <br />Crrv/ZIP tACO"pb 1 52-.Z D <br />APN OdiOLIS- PARCEL SIZE S <br />OWNER NAME ..eir) yl y -ry 11 0 511c, r PHONE <br />OWNER ADDRESS d S 3 7 Fu 1.,,J vi geif CITY/STATE/LP <br />4CC1 • 3561 13114 <br />CITY/STATE/ZIP <br /> 06P-1D <br />LICENSE 17 C-42 7 C-36 OTHER A NUMBER 5r 151 EXPIRATION DATE 202-3 <br />CONTRACTOR <br />CONTRACTOR ADDRESS <br />VJes o& •&ckheed, hoc. <br />33 Moome11 <br />PHONE <br />E PERC TEST # BUILDING PERMIT # <br /> <br />LAND USE APPLICATION # <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 /># OF LINES I LENGTH OF LINES (051 <br />ft FOUNDATION 101+ ft PROPERTY LINE 5'4 ft <br /> ft DEPTH ft <br /> ft FOUNDATION ft PROPERTY LINE ft <br /> ft DEPTH ft <br /> ft FOUNDATION ft PROPERTY LINE ft <br />ft DEPTH ft <br /> ft FOUNDATION ft PROPERTY LINE ft <br /> ft DEPTH ft <br />ft FOUNDATION ft PROPERTY LINE ft <br />30) ft DEPTH 25 ) ft <br />ft FOUNDATION I C> + ft PROPERTY LINE 151 ft <br />MOUNDED WIDTH ft LENGTH <br />DISTANCE TO NEAREST WELL <br />SUMPS WIDTH ft LENGTH <br />DISTANCE TO NEAREST WELL <br />DISPOSAL PONDS WIDTH ft LENGTH <br />DISTANCE TO NEAREST WELL <br />SEEPAGE PITS NUMBER WIDTH <br />DISTANCE TO NEAREST WELL ISD ) <br />X LEACHING CHAMBERS Ink 64,47/r <br />DISTANCE TO NEAREST WELL I DO' <br />WIDTH ft LENGTH <br />DISTANCE TO NEAREST WELL <br />I LEACH LINES <br />FILTER BED <br />Ul <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 />WATER TABLE DEPTH: 130 — I HO ft GEOGRAPHICAL INFORMATION: Coordinates X <br />TYPE OF WORK: NEW INSTALLATION de."- REPAIR/ADDITION <br />REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM <br />ENGINEER DESIGNED /ALTERNATIVE <br />DESTRUCTION <br /> <br />INSTALLATION WILL SERVE: A RESIDENCE El COMMERCIAL <br />.3 <br /> <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: <br />E OTHER <br />NUMBER OF EMPLOYEES: <br />SEPTIC TANK <br />CI GREASE TRAP <br />LIFT STATION <br />TYPE/MFG <br />TYPE/MFG <br />DISTANCE TO NEAREST: WELL <br />SIZE TYPE OF PUMP <br /> gal # OF COMPARTMENTS <br /> gal # OF COMPARTMENTS <br /> ft PROPERTY LINE <br /> <br />ft <br />LI SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />CAPACITY <br />CAPACITY <br />ft FOUNDATION <br />PKG TX PLANT <br />MIN 4 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209)953-7697 <br /> TITLE etee Q.Mta(AAAISV DATE -3130 12- t SIGNED <br />'ottt <br />PAY ENT <br />RECEIVED <br />A 3 3 2021 <br />SAN JOAQUIN COUNTY <br />NV RONNE NTAL <br />EA TH DEPARTMENT <br />Employee 104 <br />Final Inspection By /Jaa4IPø./4.5!Date / I ii02, I I- SPECIAL PERMIT -Approved by <br />Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br />COMMENTS F6 11016 systerY) , E )1:0 I" j 546' )1^ 4c). (e Wel)y. <br />PE <br />Code <br />SC <br />INFO <br />Received Check#/ <br />Cash <br />Amount <br />Remitted Date Permit/ <br />Service Request # Invoice # Permit ID# <br />Liao-) ily f 300 ;-30-2-k 5Z, 007-9-iii. <br />42-01 <br />4/14/18 coif 22 of ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />DEPARTMENT USfi ONLY <br />Application Accepted /-- Z_- Date 3 So 3 Area F