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BUILDING PERMIT # LAND USE APPLICATION # PERC TEST # <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209)468-3420 <br />NON-REFUNDABLE PERMIT CALL (20j9 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />JOB ADDRESS 2(1D2. 4 2413q- e• sT• la T. I 2- cmazip C- LE.:144 EAJT & / S. 2 Z -1 <br />CROSS STREET I3c) LI-CA APN az 3 - 2-2-0 - 01 PARCEL SIZE I 2- • 2- eir . <br />OWNER NAME G-A9gia PEP-E.Z. • _JOSE, PO2E-7.- PHONE 5.1 t) - (I L <br />OWNER ADDRESS S IPCSA, C CITY/STATE/ZIP <br />CONTRACTOR V oPc. &oVIO JT vsL PHONE 3tP4-. °I1C <br />CONTRACTOR ADDRESS 4 on Po • 0 otx cr • cirwsTATEizip LOb C-44 r 2014 0 <br />LICENSE := C-42 Li C-36 OTHER C NUMBER 2.( IC EXPIRATION DATE - <br />WATER WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X <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: U RESIDENCE <br />NUMBER OF LIVING UNITS: <br />, COMMERCIAL <br />NUMBER OF BEDROOMS: <br />L OTHER <br />NUMBER OF EMPLOYEES: <br />0 <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 U 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 />MINIMU HOUR AC/MICE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209)953-7697 <br />SIGNED TITLE 61-03 • KA.6-se. • DATE 2-1 - <br />-caL <br />16s. <br />pftimew <br />fticeveho <br /> 2 8 2021 <br />JCIAQ'IN couN.,,, rt., DE.Air Enn-44 <br />Application Accepted By <br />7, DEPARTMENT ,E ONLY <br />/' Date 51.1P .2 Area (I / Ci4 Employee ID# <br />U <br /> FR 4'74fENT <br />Final Inspection By rto, Ati; 1 • Lte•beellt I/Irt: 11 SPECIAL PERMIT - Approved by <br />...- . . <br />1. 04014 Date <br />Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br />COMMENTS <br />4414. z_ —> <br />ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />PE <br />Code <br />SC <br />INFO <br />Received <br />By <br />(... Check*/ <br />_ Cash <br />Amount <br />Remitted Date Permit/ <br />Service # Invoice # Permit ID# <br />ila‘* s-a3 div-/-6 1 -q--11-)_)f 301-1 tS'fri <br />M <br />s :SS311(1,31/ 311S 42-01 <br />ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4/14/18