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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 />JOB ADDRESS 9tocf AA kr2-( tsr P-1> • crreizip STDC-k-TbA, ci C 2-I r <br />CROSS STREET St 1. " AN A APN PARCEL SIZE 3. .5"--? 4e. <br />PHONE (J> Le 7-2- <br />OWNER ADDRESS .5 Pr 114E: CITY/STATE/ZIP <br />CONTRACTOR LJt- PINK O,vT,L PHONE 31A - or) <br />CONTRACTOR ADDRESS 140 -7 IA) • 0 AK. ST' • <br />OWNER NAME A-1.16-E2A eneei-JA S <br />lei -ocv- <br />orris-I-ATE/zip L.. 01) cA 47 2.4 ti <br />LICENSE := C-42 C-36 OTHER c eG NUMBER 21 S- I EXPIRATION DATE 4 -30 - <br />e.;471 <br />ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />WATER TABLE DEPTH: <br /> <br />ft GEOGRAPHICAL INFORMATION: Coordinates X <br /> <br />PERC TEST # <br /> <br />BUILDING PERMIT # LAND USE APPLICATION # <br /> <br />TYPE OF WORK: NEW INSTALLATION <br />REPLACEMENT . <br />REPAIR/ADDITION <br />OUT-OF-SERVICE SEPTIC SYSTEM <br />ENGINEER DESIGNED /ALTERNATIVE <br />DESTRUCTION <br />INSTALLATION WILL SERVE: RESIDENCE <br />NUMBER OF LIVING UNITS: <br />COMMERCIAL <br />NUMBER OF BEDROOMS: <br />OTHER <br />NUMBER OF EMPLOYEES: <br />0 <br />0 <br />SEPTIC TANK TYPE/MFG CAPACITY gal # OF COMPARTMENTS <br />GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS <br />DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br />LIFT STATION SIZE TYPE OF PUMP PKG TX PLANT 0 SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />0 LEACH LINES LEACHING CHAMBERS # OF LINES LENGTH OF LINES ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />0 FILTER BED WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />0 MOUNDED WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />0 SUMPS WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />0 DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />0 SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <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/ UR AZCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209)953-7697 <br /> TITLE PX0-1. 041g 6 • DATE - 0 i - - - 2 I <br />Mei <br />Application Accepted B <br />Final Inspection By Date 9 37-202-1-] SPECIAL PERMIT -Approved by <br />Character of Soil to Depth of 3 Ft: Pit/Sump Soil Charayter: <br />0 COMMENTS '-eel,' pr -c. Q.• .417 it <br />PE <br />Code <br />SC <br />INFO <br />Received <br />B <br />C Che_90( <br />e ash <br />Amount <br />Remitted Date Permit/ <br />Service Request # Invoice # Permit ID# <br />LWD S''2 3 ' <br />0/(4; <br />I --q-te , f i•Col 411611-i SPC0q51P3 <br />SIGNED <br />DEPARTMENT USE ONLY <br />Date Ly/f, d J Area )/'i Employee ID# :SMICICIV 31IS 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4/14/18