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CITY/STATE/ZIP OWNER ADDRESS F,0 77'4 <br />NON-REFUNDABLE PERMIT CALL (209) 953-7697 FOR INSPECTIONS <br />z7z,ee A ilt(204/ <br />/2d <br />XPIRES 1 YEAR FROM DATE ISSUED <br />PHONE zof -,</a <br />(..41/1 qs-d <br />JOB ADDRESS <br />CROSS STREET <br />OWNER NAME <br />APN 0°1304-13F° PARCEL SIZE a <br />1;i1N, A 1 A,,A) <br />CONTRACTOR <br />CONTRACTOR ADDRESS <br />LICENSE [11 C-42 01 .C-36 OTHER <br />/fie, kAA, AiriApAg <br />‘/-imt <br />PHONE 7i 4 'g) /4519 <br />CITY/S TATE/ZIP r712:54112;44,/ ‘., '- <br />NUMBER e4--,7(23EXPIRATION DATE <br />Li PERC TEST # BUILDING PERMIT # a oc z-x' 6 eo <br />LAND USE APPLICATION # <br />DISTANCE TO NEAREST: WELL <br />/44, SEPTIC TANK TYPE/MFG <br />GREASE TRAP TYPE/MFG <br />ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAzELToN AVENUE - STOCKTON CA 95205 -(209) 468-3420 <br />WATER TABLE TABLE DEPTH: 1 S — 160 ft GEOGRAPHICAL INFORMATION: Coordinates X <br /> <br />TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION <br />ENGINEER DESIGNED /ALTERNATIVE <br />REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> <br />INSTALLATION WILL SERVE: 1<RESIDENCE <br /> <br />L COMMERCIAL <br /> C OTHER <br /> <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> CAPACITY /Z62 gal # OF COMPARTMENTS <br /> CAPACITY gal gal # OF COMPARTMENTS <br />ft FOUNDATION ft PROPERTY LINE ft <br />LIFT STATION SIZE TYPE OF PUMP U PKG TX PLANT 0 SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br /> <br /># OF LINES ...3 LENGTH OF LINES _C-75-- i ft <br />FOUNDATION /o 14 ft .. PROPERTY LINE -4 )4 ft <br /> ft DEPTH ft <br />ft FOUNDATION ft PROPERTY LINE ft <br /> <br />ft DEPTH ft <br />ft FOUNDATION ft PROPERTY LINE ft <br /> ft DEPTH ft <br />ft FOUNDATION ft PROPERTY LINE ft <br /> <br />ft DEPTH ft <br /> ft PROPERTY LINE ft <br />WIDTH_ 40 stl il ft DEPTH 2.. 4-* ' ft <br /> ft PROPERTY LINE 5- 1-7L 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 />ANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 <br /> TITLE DATE <br />to LEACH LINES <br />FILTER BED <br />MOUNDED <br />SUMPS WIDTH ft LENGTH <br />DISTANCE TO NEAREST WELL <br />CI DISPOSAL PONDS WIDTH ft LENGTH <br />LEACHING CHAMBERS <br />DISTANCE TO NEAREST WELL <br />WIDTH ft LENGTH <br />DISTANCE TO NEAREST WELL <br />WIDTH ft LENGTH <br />DISTANCE TO NEAREST WELL <br />DISTANCE TO NEAREST WELL ft FOUNDATION <br />g SEEPAGE PITS NUMBER <br />DISTANCE TO NEAREST WELL ) ft FOUNDATION :SS3ZIUCIV 311S Application Accepted g;v• <br />Final Inspection By ff4.1WVMF <br />Character of Soil t. Depth of 3 Ft: <br />COMMENTS tJr-vJ .5 p . <br />EPARTMENT U E ONLY <br />Date / 21 <br />&74111 <br /> <br />T. <br />"AR TtoEN 7 <br />Area Employee ID# fYi <br />Li SPECIAL PERMIT - Approved by Date <br />Pi Sump Soil Character: <br />PE <br />Code <br />SC <br />INFO <br />Received <br />By <br />Amount <br />Remitted Date i Permit/ <br />Service Re uest # Invoice # Permit ID# <br />Liaii 1 17 <br />t joy/. <br />20d-fef ls-s7i) iP 1u212, 4D0' . 1-s- <br />42-01 <br /> ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4/14/18