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JOB ADDRESS Z 0 i\j yo> . ciTyizip qS10 k <br />CROSS STREET WIOW.e(.. OWN A.) E APN 001 - I 5-0 - t-t k PARCEL SIZE e)• 6, AC • <br />OWNER NAME -rz ttE ktCr Wet ie. PHONE (67(.0) VD tfrq <br />OWNER ADDRESS IX Wiz 1 ce C-"T • 5 Tr • I-1 crysTATEtzip A/Twerp t, eft 7413 <br />CONTRACTOR LtvE 0 Md. Gt.° CAA/ I Rot,/ tvielui-"L <br />CONTRACTOR ADDRESS 4401 IA.) • OAKS T. <br />PHONE 3tt -o37ç <br />ordsTATErzip LetI, C A 9 <br />LICENSE C-42 C-42 C-36 OTHER C C-6- NUMBER 2.Ic 1 EXPIRATION DATE 44 3 <br />,AO Ke-Lu <br />Application Accepted <br />DEPARTMENTISE ONLY <br />Date ,S' ,2 Area q 9 Employee ID# <br />Final Inspection By A4sevrwdA- Date to --: SPECIAL PERMIT - Approved by <br />Character of Soil to Depth of 3 Ft, JP.Lt/2:1p Soil Character: <br />COMMENTS/2W-C-14,61-1 <br />Rec <br />N A <br />• <br /> PAYA,1 -.E"Afr <br />11,11) <br /> 2021 <br />E:lvv.R QA,41.1v <br />0 ‘vi y <br />TwAtr. <br />7111•J <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: <br /> <br />ft GEOGRAPHICAL INFORMATION: Coordinates X <br /> <br />PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # <br />TYPE OF WORK: NEW INSTALLATION <br />REPLACEMENT <br />REPAIR/ADDITION <br />OUT-OF-SERVICE SEPTIC SYSTEM <br />ENGINEER DESIGNED/ALTERNATIVE <br />DESTRUCTION <br /> <br />INSTALLATION WILL SERVE: RESIDENCE H COMMERCIAL <br /> <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: <br />u OTHER <br />NUMBER OF EMPLOYEES: <br />(1 <br />CI <br />SEPTIC TANK <br />GREASE TRAP <br />TYPE/MFG CAPACITY gal # OF COMPARTMENTS <br />TYPE/MFG CAPACITY gal # OF COMPARTMENTS <br />DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br />CI LIFT STATION SIZE TYPE OF PUMP PKG TX PLANT CI 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 />CI 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 />MINIMU HOURMANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209)953-7697 <br /> TITLE ele4U & DATE 5 -z1- 21 <br />PE <br />Code <br />SC <br />INFO <br />Received <br />B <br />tC.biCkiti Amount <br />Cash Remitted Date Permit/ <br />Service Request # Invoice # Permit ID# <br />11.2,3, C .3 <br />tat, <br />1-17-2-)41ca 5 ID ' 3-7 Sg <br />SIGNED :SSMICKIV 311S 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4/14/18