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-7, (-) PARCEL SIZE <br />LAND USE APPLICATION # BUILDING PERMIT # <br />IH <br />TYPE OF WORK: II ENGINEER DESIGNED /ALTERNATIVE <br />I DESTRUCTION <br />NEW INSTALLATION REPAIR/ADDITION <br />REPLACEMENT j 4.4,r L L OUT-OF-SERVICE SEPTIC SYSTEM <br />WATER TABLE DEPTH: Lft5rS ik&vt 10 ft GEOGRAPHICAL INFORMATION: Coordinates X <br />E PERC TEST # <br />PHONE <br />INSTALLATION WILL SERVE: RESIDENCE <br />NUMBER OF LIVING UNITS: <br />0 COMMERCIAL <br /> <br />E OTHER <br />NUMBER OF BEDROOMS: <br />NUMBER OF EMPLOYEES: <br />JOB ADDRESS 3 crryizip f/14 y1 J-e66% <br />CROSS STREET F APN d 030 A° <br />OWNER NAME Pi; 4 <br />OWNER ADDRESS Jci CITY/STATE/ZIP <br />CONTRACTOR ,r/eptie-- SZvet PHONE <br />/-ç' <br />LICENSE 0 r 1C-42 C-36 OTHER A NUMBER —)lijST? EXPIRAllON DATE <br />CONTRACTOR ADDRESS CITY/STATE/ZIP <br />953V -2 <br />_s- &-‘ r? <br />PAymEAft. <br />Rs,,cr, 7-vea <br />3 2021 8.4N .0AQu co <br />HE44Titpe MENTZ <br />14.4R TMENr <br />47 <br />MAY 2 <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 />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 U PKG TX PLANT 0 SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />LEACH LINES LEACHING CHAMBERS # OF LINES LENGTH OF LINES ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />a FILTER BED WIDTH 7 (7) ft LENGTH 7 2_ ft DEPTH / ft <br />DISTANCE TO NEAREST WELL .,.../c),_:, . ft FOUNDATION 4,---1 ' ft PROPERTY LINE ft <br />CI MOUNDED WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />SUMPS WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL <br /> <br />ft FOUNDATION <br /> <br />ft PROPERTY LINE <br /> <br />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 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209)953-7697 <br />SIGNED TITLE ,5- DATE .9, <br />DEPARTMENT U7 ONLY <br />.---'----; 2- 2--- AG Application Accepted By Date ‘/ 5',2 ) Area 5-1 q Employee ID# <br />Final Inspection By Tf?4,14 S (....s (pAr ,-C...`or, aufz2 z_ Date .51Zr 7 /7F2-,/ C SPECIAL PERMIT -Approved by <br />Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br />COMMENTS frt ) 0 ier %.0 SYS49111' a Y ii-ili,.5 1 MeS. -.to 'be 4110 0reri 0 dc'n <br />PE <br />Code <br />SC <br />INFO <br />Received <br />By <br />CCheck#1.--' Amount <br />Remitted Date Permit/ <br />Service Request # Invoice # Permit ID# Cash <br />1449 ID ils- Aiz t5062,/-f *300 12s,( soog3-7(02_ <br />42-01 <br /> <br />ONSITE WASTEWATER TRTMNT SYSTEM PERMIT :SS31,100 V 311S 4/14/18