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ENGINEER DESIGNED /ALTERNATIVE NEW INSTALLATION REPAIR/ADDITION REPLACEMENT L OUT-OF-SERVICE SEPTIC SYSTEM n DESTRUCTION NUMBER OF EMPLOYEES: 0 OTHER RE)SIDENCE LI COMMERCIA NUMBER OF BEDROOMS: INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS: BUILDING PERMIT # LAND USE APPLICATION # 0 PERC TEST # TYPE OF WORK: X ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 -(209) 468-3420 NON-REFUNDABLE PERMIT CALL (209) 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED k---frio CROSS STREET APN 11°1 2 li) 3 PARCEL SIZE OWNER NAME Ali r lip leir 41'016+0 PHONE OWNER ADDRESS CITY/STATE/ZIP CONTRACTOR CJ""/ Va I ly Fe,le PHONE (720 6? CONTRACTOR ADDRESS 37 '7* .--trk.e07 44 0- CITY/STATE/ZIP ....(A)--44, Of 9-57:?/ LICENSE OtiiC-42 00C-36 OTHER NUMBER EXPIRATION DATE JOB ADDRESS r9 73 7 *Ttscr— WATER TABLE DEPTH: GEOGRAPHICAL INFORMATION: Coordinates X SEPTIC TANK TYPE/MFG CAPACITY c2000 gal # OF COMPARTMENTS 0 GREASE TRAP TYPE/MFG ‘C, k/C1-14 CAPACITY gal # OF COMPARTMENTS DISTANCE TO NEAREST: WELL /00 ft FOUNDATION ft PROPERTY LINE ft 0 LIFT STATION SIZE TYPE OF PUMP U PKG TX PLANT CI SAND OIL SEPARATOR (ENCLOSED SYSTEM) :SS311(10V 311S K LEACH LINES E LEACHING CHAMBERS DISTANCE TO NEAREST WELL /00 ' 0 FILTER BED WIDTH ft LENGTH DISTANCE TO NEAREST WELL 0 MOUNDED WIDTH ft LENGTH DISTANCE TO NEAREST WELL 0 SUMPS WIDTH ft LENGTH DISTANCE TO NEAREST WELL 0 DISPOSAL PONDS WIDTH ft LENGTH - . /4.- DNIUSMTABNCE TO NEAREST WELL ft FOUNDATION -...- I i ft PROPERTY Llf\l'EH pep-il i r VrA/.. ft 2 SEEPAGE PITS ER 3) WIDTH ft DEPTH - - ifikAir ft DISTANCE TO AREST WELL /6-0 1 ft FOUNDATION /$"o i ft PROPERTY LINE 5- 1 ft # OF LINES ( 3 ) LENGTH OF LINES 575- / ft ft FOUNDATION 70 6 / ft PROPERTY LINE 5.— ' ft ft DEPTH ft ft FOUNDATION ft PROPERTY LINE _ me PAY ft ft DEPTH Rece NT ft ft FOUNDATION ft PROPERTY LINE /VE-D ft ft DEPTH Alfl? 09 2021 ft ft FOUNDATION ft PROPERTSOUNakciv r ft ft DEPTHki4IVV/FionivRAIN COuNry ft I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. MINIMUM 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTI NS 7 PLEASE CALL (209) 953-7997 SIGNED -67 TITLE 4; e/f 0-- DATE — I DEPARTMENT U E ONLY Application Accepted: ,.. /1.4 Date tt Employee ID# -161" Ida vt Wrixr 76z Area Final Inspection By 007,, Date 11/ i'2402.1 0 SPECIAL PERMIT -Approved by Character of Soil to Dep h of 3 Ft: Pit/ S ump Soil Character: COMMENTS .ce.12-- 3/ Og Z°Z-/ AiL-5/-5S SpOYLS12 -Q -(+e r PE Code SC INFO Received hec Amount Remitted Date Permit/ Service Request # Invoice # Permit ID# 2._ 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18