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JOB ADDRESS q94.i. A,•.-..1-P.'/T;-' CITY/ZiPf--;A_I-.139.1.--) CA- <br />OWNER NAME .1-5-10 r,up, L.itX PHONE 3,5J D3.$/ <br />PARCEL SIZE /(:1 0 A C CROSS STREET WAUe. QCV <br />APN 061394,0 N <br />OWNER ADDRESS fuip:? 7..-Heirau gb CITY/STATE/ZIP (2 Al f7 *Y--= <br /> <br />CONTRACTOR _4 <br />CONTRACTOR ADDRES: <br />LICENSE IJC-42 _,C-36 OTHER <br /> <br />PHONE <br />CITY/STATE/ZIP <br /> <br />NumBE <br /> <br />EXPIRATION DATE <br /> <br />INSTALLATION WILL SERVE: ;6- RESIDENCE <br />NUMBER OF LIVING UNITS: <br />C COMMERCIAL C OTHER <br />NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br />TYPE OF WORK: NEW INSTALLATION I I REPAIR/ADDITION I I <br />ENGINEER DESIGNED /ALTERNATIVE <br />REPLACEMENT H OUT-OF-SERVICE SEPTIC SYSTEM I DESTRUCTION :SS311CICIV 311S 9 <br />ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - S-rock-roN 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: <br /> i&.5 <br />GEOGRAPHICAL INFORMATION: Coordinates X • 3a.06‘273y -.17 0.13506 5- <br /> <br />BUILDING PERMIT #_gp-zez>c(Licib LAND USE APPLICATION # E PERC TEST # <br /> <br />,Ze—SEPTIC TANK TYPE/MFG C0/JC.P4C-) e r * L (ext.PePACITY / OC) gal <br />GREASE TRAP TYPE/MFG CAPACITY gal <br />/0 ft <br />PKG TX PLANT 0 SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />DISTANCE TO NEAREST: WELL 3qo <br />ft FOUNDATION <br /># OF COMPARTMENTS <br /># OF COMPARTMENTS <br />PROPERTY LINE ft <br />CI LIFT STATION <br /> <br />SIZE <br /> <br />TYPE OF PUMP <br />LEACH LINES <br />FILTER BED <br />MOUNDED <br />SUMPS <br />DISPOSAL PONDS <br />SEEPAGE PITS <br />LEACHING CHAMBERS <br />DISTANCE TO NEAREST WELL ft FOUNDATION <br />WIDTH ft LENGTH <br />DISTANCE TO NEAREST WELL ft FOUNDATION <br />ft FOUNDATION <br />ft FOUNDATION <br />LENGTH OF LINES /Q ft <br />ft PROPERTY LINE Lb # ft <br />DEPTH ft <br />ft PROPERTY LINE ft <br />ft <br /> ft PROPERTY LINE ft <br />ft DEPTH ft <br />ft PROPERTY LINE ft <br />ft DEPTH <br />ft <br />ft <br />PROPERTY LINE ft <br />ft DEPTH ft <br /> ft PROPERTY LINE ft <br />DISTANCE TO NEAREST <br />WIDTH ft LENGTH <br />DISTANCE TO NEAREST WELL <br />WIDTH ft LENGTH <br />WELL I G; ft FOUNDATION <br />WIDTH ft LENGTH <br />DISTANCE TO NEAREST WELL <br />NUMBER WIDTH <br />DISTANCE TO NEAREST WELL <br /># OF LINES <br />ft FOUNDATION <br />ft DEPTH <br />TI AT I HAVE P ARED THIS APP ATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br />STAT t S AN RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br />REQUIRED FOR INS CTIONS - PLEASE CALL (209) 953-769 <br /> TITLE 4-4 t..L4j r DATE <br />( 'a <br />°tate 44/ 23/Z- <br /> Pit/Sump Soil Character: <br />COMMENTS Seci FR. "ner Nv ..)ellc se1-64cks rer EI-10 rezoids, <br />SoJ 1z) be veoGel ihspec.4-;or5,s.):1 f re,r 12,0 C;ivz, (66)e foi kt,th ilvirs per <br />c t2 oo-N 41; stiz popt-t))/ "1 dol. <br />PE <br />Code <br />SC <br />INFO <br />Received Check#/ <br />Cash <br />Amount <br />Remitted Date <br />. <br />Permit/ <br />Service Request # Invoice # Permit ID# <br />Li i 1 117 (42 (d4-)' 4s '9 2-26 zi 5a on-33i--1 <br />Application Accepted Accepted <br />Final Inspection By <br />Character of Soil t <br />DEPARTMENT US; ONLY <br /> Date -7/676- d Area 14/V ii Employee ID# <br />E SPECIAL PERMIT Approved by <br />42-01 <br />4/14/18 0)17) ON/SITE WASTEWATER TRTMNT SYSTEM PERMIT