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dingzip Pc.Cli•c**r%c)9 p G;e Q JOB ADDRESS 1 c‘311) CO 14.4 <br />001 -0 4 0 -40 ODD PARCEL SIZE ( 0 S <br />pHoNicek) 3 — <br />1c0 Pc 1) <br />%056f..1 <br />APN CROSS STREET <br />OWNER NAME <br />LICENSE 14-42 El DC-36 OTHER <br />CONTRACTOR Ce*J7 aPTI, kr itt,L 1 5(o-9-T \ (-- PHONO OCk) CAC\ 3 - 41 t6., 5 <br />CONTRACTOR ADDRESS COL-1 FTZ-. c2N t. A CITY/STATE/ZIP I:\ 6 _1\AA 9 0 Ci,, 9 --c <br />NUMBER qs-elovs-- EXPIRATION DATE <br />ft GEOGRAPHICAL INFORMATION: Coordinates X WATER TABLE DEPTH: <br />REPAIR/ADDITION <br />OUT-OF-SERVICE SEPTIC SYSTEM <br />BUILDING PERMIT # i(9I2 .7 LAND USE APPLICATION # <br />I I ENGINEER DESIGNED /ALTERNATIVE <br />DESTRUCTION <br />COMMERCIAL <br />NUMBER OF BEDROOMS: <br />INSTALLATION WILL SERVE: RESIDENCE <br />NUMBER OF LIVING UNITS: NUMBER OF EMPLOYEES: <br />C OTHER <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 />PERC TEST # <br />TYPE OF WORK: NEW INSTALLATION <br />REPLACEMENT <br />OWNER ADDRESS L1 (p ‘4\.) q-,01;‘0 Orr/STATE/ZIP S:.\ 814\ cr 01 - <br />C "V €119, pod CAPACITY <br />CAPACITY <br />DISTANCE TO NEAREST: WELL /00 P ft FOUNDATION /0 <br />TYPE OF PUMP <br /> <br />PKG TX PLANT <br />gal # OF COMPARTMENTS a <br />gal # OF COMPARTMENTS <br />ft PROPERTY LINE 170 ft <br />SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />42 SEPTIC TANK TYPE/MFG <br />GREASE TRAP TYPE/MFG <br />LIFT STATION SIZE <br />4bECE1 <br />ktiR 1 9 <br />Jcb4 <br />Q414, U/Ar 441. Itto Co <br />'H0E1147:4771' <br />2021 Atv <br />44" A <br />Application Accepted B AP <br />-41M. <br />Final Inspection By <br />Character of Soil to De o'of 3 F V <br />COMMENTS <br />US ONLY <br />1/ Area Employee ID# <br />C SPECIAL P RMIT - Approved by <br />Pi Sump Soil Character: <br />EPARTMEN <br />Date <br />Date <br />PE <br />Code <br />SC <br />INFO <br />Received <br />By <br />dhe Amount Date i <br />Permit/ <br />Service Request # Invoice # Permit ID# Cash <br />4V 1 tn ,Reirp <br />n9-6 2/-1 -L*-_s- 3/Kg 124 e ocog3t1-37 <br />ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 42-01 <br />4/14/18 :SS31102IV 3.11S # OF UNEs .(3) LENGTH OF LINES s-s- ' ft <br />WELL /00 / ft FOUNDATION <br />/ <br />/d ft PROPERTY LINE ,5-1- ' ft <br /> ft DEPTH ft <br /> <br />ft FOUNDATION ft PROPERTY LINE ft <br /> ft DEPTH ft <br /> <br />ft FOUNDATION ft PROPERTY LINE ft <br /> ft DEPTH ft <br /> <br />ft FOUNDATION ft PROPERTY LINE ft <br /> <br />ft DEPTH ft <br /> ft PROPERTY LINE ft <br />WIDTH ft DEPTH •13S-P ft <br /> <br />ft FOUNDATION SO P ft PROPERTY LINE Vs' 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 />UR ANCE NOTICE R Ul D FOR INSPECTIONS - PLEASE CALL (209) 953-7697 <br />SIGNED TITLE b1A-) t.) DATE <br />it <br />)it SEEPAGE PITS NUMBER <br />LEACH LINES <br />CI FILTER BED <br />MOUNDED <br />SUMPS <br />DISTANCE TO NEAREST <br />WIDTH <br />DISTANCE TO NEAREST <br />WIDTH <br />DISTANCE TO NEAREST <br />WIDTH <br />DISTANCE TO NEAREST <br />DISPOSAL PONDS WIDTH ft LENGTH <br />DISTANCE TO NEAREST WELL <br />(! ) <br />DISTANCE TO NEAREST WELL /so' <br />LEACHING CHAMBERS <br />ft LENGTH <br />WELL <br />ft LENGTH <br />WELL <br />ft LENGTH <br />WELL <br />ft FOUNDATION <br />'12-"