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SEPTIC TANK <br />GREASE TRAP <br />LIFT STATION <br />CAPACITY <br />TYPE/MFG CAPACITY <br />DISTANCE TO NEAREST: WELL ft FOUNDATION <br />SIZE TYPE OF PUMP ID PKG TX PLANT <br />TYPE/MFG # OF COMPARTMENTS <br /># OF COMPARTMENTS <br />PROPERTY LINE <br />SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />gal <br />gal <br />ft ft <br /> ft PROPERTY LINE ft ft FOUNDATION <br />ft PROPERTY LINE ft DISTANCE TO NEAREST WELL • ft FOUNDATION <br />NT SE N L <br />Date <br />Date <br />- Atria <br />JOB ADDRESS 17— 00 I Al • 71/1...l-q OLD. . et cx d-rb CITY/ZIP 1.--DPI <br />ESPr f-I3 A OWNER NAME <br />CROSS STREET yo be-14-%1 APN °UK-- - PARCEL SIZE 10. 9 At • <br />PHONE 63`1 Gp k <br />Pf CITY/STATE/ZIP <br />PHONE 3 Lo9 31 S. CONTRACTOR GUM 001*- 6-e-OENv )1ei:5_1•MN Vs-$-111 L <br />OWNER ADDRESS <br />WATERTABLE DEPTH: 1515 ft GEOGRAPHICAL INFORMATION: Coordinates X <br />PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # <br />REPAIR/ADDITION <br />OUT-OF-SERVICE SEPTIC SYSTEM <br />NEW INSTALLATION <br />REPLACEMENT <br />ENGINEER DESIGNED/ALTERNATIVE <br />DESTRUCTION <br />TYPE OF WORK: <br />INSTALLATION WILL SERVE: RESIDENCE _ OTHER <br />NUMBER OF EMPLOYEES: NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: <br />_ COMMERCIAL <br />1 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 />CONTRACTOR ADDRESS 4401 h.) • 0 P% T. ordsTATEmp oBt c c-.1Ot <br />LICENSE _ C-42 C-36 OTHER C NUMBER 31S EXPIRATION DATE - 3 0 2- 2.. :SSDRICIV 311S LEACH LINES LEACHING CHAMBERS <br />DISTANCE TO NEAREST WELL <br />FILTER BED WIDTH ft LENGTH <br />DISTANCE TO NEAREST WELL <br />MOUNDED WIDTH ft LENGTH <br />DISTANCE TO NEAREST WELL <br />CI SUMPS WIDTH ft LENGTH <br />DISTANCE TO NEAREST WELL <br />DISPOSAL PONDS WIDTH ft LENGTH <br />DISTANCE TO NEAREST WELL <br />SEEPAGE PITS NUMBER WIDTH <br />ft DEPTH ft <br /> ft PROPERTY LINE ft <br />ft DEPTH ft <br /> ft PROPERTY LINE ft <br />ft DEPTH ft <br /> ft PROPERTY LINE ft <br /> <br />ft DEPTH ft <br /># OF LINES LENGTH OF LINES ft <br />ft FOUNDATION ft PROPERTY LINE ft <br /> ft DEPTH ft <br />pc <br />Application Accepted By ...AI d_A <br />Final Inspection By <br />Character of Soil topeoth of 3 Ft: <br />1111KI , <br />COMMENTS <br />,ase,,x1/ <br />40(7-- <br />Area Employee IDP <br />= SPECIAL PERMIT - Approved by J <br />Character 202/ <br />/--€717,1A Al JO/1Q <br />1-zat ri r, N4e4,10 , 7), _84s,r <br />PE SC <br />Code INFO <br />Received <br />B <br />eck#/ Amount <br />Remitted Date Permit/ <br />Service Request # Invoice # Permit ID# <br />ik /7,1.- 573 I-Ti-Li 1 52._ (4iv/2/ -P01)33'1 1 <br />ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />ft FOUNDATION <br />ft FOUNDATION <br />ft FOUNDATION <br />Pit/Sump Soil <br />rif <br />42-01 <br />4/14/18