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CROSS STREET Vt'cl (_ ve 1-1C/61. <br />OWNER NAME 10 phi ( 10 f <br />OWNER ADDRESS 6 5 M ,..:11/1 11 t <br />CONTRACTOR <br />CONTRACTOR ADDRESS 3 7 Lf <br />644 iv,/ 1/4 1 <br />3) <br />E OTHER <br />NUMBER OF EMPLOYEES: <br />LENGTH OF LINES ilo ' ft <br />ft PROPERTY LINE ft <br />DEPTH ft <br />ft PROPERTY LINE <br />DEPTH <br />ft PROPERTY LINE <br />DEPTH <br />ft PROPERTY LINE <br />DEPTH <br />ft <br />ft <br />ft <br />ft <br />ft <br />ft <br />APR 1+a 44A, 6 <br />IVA( <br />fte triElti l" Ofrzo <br />AAA !My ,.... rwoA,.. s-ou. <br /> <br />rtic, ""fiTiv iv TY <br />"IkrAfr <br />See <br />Area 14/q4 Employee ID# <br />SPECIAL PERMIT - Approved by <br />ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 -(209) 468-3420 <br />JOB ADDRESS q6..."-C I ' <br />CALL (209) 953-769 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED NON-REFUNDABLE PERMIT <br />CITY/ZIP e C <br />AP N 00731° 3 / PARCEL SIZE Li <br />PHONE <br />CITY/STATE/ZIP Ace,olp 3 (75-01 0 <br /> PHONE 4 7 36,9--5vd7 <br />rtitt <br />CITY/STATE/ZIP L Siet-Wev-g/ _..5-(3(7 <br />LICENSE E K.-42 E EC-36 OTHER NUMBER <br /> EXPIRATION DATE <br />WATER TABLE DEPTH: 1I I <br />ft GEOGRAPHICAL INFORMATION: Coordinates X <br /> <br />BUILDING PERMIT # S)030? S <br /> <br />PERC TEST # LAND USE APPLICATION # <br />TYPE OF WORK: ,\S( NEW INSTALLATION <br />H REPLACEM EN <br />REPAIR/ADDITION <br />OUT-OP-SERVicE SEPTIC SYSTEM <br />ENGINEER DESIGNED /ALTERNATIVE <br />DESTRUCTION :s.S311(113V 31IS ?S. RESIDENCE INSTALLATION WILL SERVE: <br />NUMBER OF LIVING UNITS: <br />E COMMERCIAL <br />NUMBER OF BEDROOMS: <br /> <br />okvedte CAPACITY gal # OF COMPARTMENTS c?.. <br /> CAPACITY gal # OF COMPARTMENTS <br /> <br />DISTANCE TO NEAREST: WELL A9C) (-- ft FOUNDATION 20 ft PROPERTY LINE /00 r ft <br />A- SEPTIC TANK <br />GREASE TRAP <br />TYPE/MFG <br />TYPE/MPG <br />LIFT STATION SIZE TYPE OF PUMP PKG TX PLANT 0 SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />11( LEACH LINES <br />FILTER BED <br />MOUNDED <br />SUMPS <br />DISPOSAL PONDS <br />\%Ic SEEPAGE PITS <br />_ LEACHING CHAMBERS <br />DISTANCE TO NEAREST WELL /6267 f ft FOUNDATION :?3 <br /># OF LINES (cP <br />WIDTH ft LENGTH <br />DISTANCE TO NEAREST WELL ft FOUNDATION <br />WIDTH ft LENGTH <br />DISTANCE TO NEAREST WELL ft FOUNDATION <br />WIDTH ft LENGTH <br />DISTANCE TO NEAREST WELL ft FOUNDATION <br />WIDTH ft LENGTH <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE <br />NUMBER ( 171 ) WID TH -4. Y " e ft DEPTH <br />DISTANCE TO REAREST WELL jE2 f ft FOUNDATION r7C ft PROPERTY LINE <br />ft <br />ft <br />ft <br />ft <br />ft <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 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLE SE CALL (209) 953-7697 <br />SIGNED <br /> (2_ TITLE DATE /7/ --/te <br />CEPA RTMENTiy*E ,ONLY <br /> Date 4//c/s' Application Accepted By <br />Final Inspection By /(!3/56it:71Th <br />Character of Soil to Depth of 3 Ft: <br />COMMENTS fJeq,/ SW /Pr JJ <br />Date Cz. <br />Pit/Sump Soil Character: <br />n c j- II 3-e, mitt/in_ 3.'10 HuA t S: 71 pi Ankc <br />PE <br />Code <br />SC <br />INFO <br />Received <br />,v <br />.r.pr.ferP <br />Cash Cash <br />Amount <br />Remitted Date Permit/ <br />Service Request # Invoice # Permit ID# <br />L 1 4) 1 I i7 2'+2J '70 + s- ? li <br />42-01 <br /> <br />ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4/14/18