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APN PARCEL SIZE as <br />PHONE 2 - (379 <br />crryisTATEizip < 4 /or ) r <br />PHONE afr 65.0Z <br />ciTyisTATEizip5SCQ 417 /6, 9,(3A9 <br />ft FOUNDATION I ft PROPERTY LINE Z. ft <br />ft DEPTH ft <br />ft PROPERTY LINE ft <br /> ft DEPTH <br />SEEPAGE PITS NUMBER WIDTH ft DEPTH afti/R IN CO(' ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE r*PArrA jrrAL ft <br />WELL <br />ft LENGTH <br />ft LENGTH <br /> ft FOUNDATION ft PROPERTY LM/A joAQu <br /> ft <br />DEPTH PROPERTY LINE <br /> ft DEPTH mAY 2 ' ft <br />ft FOUNDATION ft PROPERTY LINE 411 Af .r.ft <br /> <br />ft FOUNDATION ft <br />riECEIVE.01 ftft <br />HCA TH L ()AIM Ai TY <br />1, <br />- mE/yr <br />2021 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 />DISTANCE TO NEAREST: WELL <br />LIFT STATION SIZE TYPE OF PUMP <br />I), LEACH LINES <br />CI FILTER BED WIDTH ft LENGTH <br />DISTANCE TO NEAREST WELL <br />ID MOUNDED WIDTH ft LENGTH <br />DISTANCE TO NEAREST WELL <br />CI SUMPS WIDTH <br />DISTANCE TO NEAREST <br />DISPOSAL PONDS WIDTH <br />DISTANCE TO NEAREST WELL <br />SEPTIC TANK <br /> <br />TYPE/MFG <br />GREASE TRAP <br /> <br />TYPE/MFG <br />I LEACHING CHAMBERS <br />WELL '9?) <br /> CAPACITY <br /> CAPACITY <br />ft FOUNDATION <br /> gal # OF COMPARTMENTS <br />gal # OF COMPARTMENTS <br />ft PROPERTY LINE ft <br />DISTANCE TO NEAREST <br />ft FOUNDATION <br />PKG TX PLANT <br /> 0 SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br /># OF LINES I b01 LENGTH OF LINES ft <br />NST6b Q1(11-5L <br />INN =NMI/ <br />c4Y ,-k <br />NZ <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 />JOB ADDRESS 9q /V <br />CROSS STREET <br />OWNER NAME gr/ .e) <br />Z VG/ #441 A." <br />6,0 57 -4.7t C617) I <br />13 Alder /2 <br />ciryizip 65:-.5Z. /a 11 <br />OWNER ADDRESS <br />CONTRACTOR <br />CONTRACTOR ADDRESS 1SS3tI1CIV 311S NUMBER 797716 EXPIRATION DATE LICENSE C-42 C C-36 OTHER 4-A <br />WATER TABLE DEPTH: ?o <br />ft GEOGRAPHICAL INFORMATION: Coordinates X <br />PERC TEST # <br />TYPE OF WORK: NEW INSTALLATION I REPAIR/ADDITION <br /> <br />z>‹. REPLACEMENT 6 4 't_4(.4‘ 64E- I OUT-OF-SERVICE SEPTIC SYSTEM <br />INSTALLATION WILL SERVE: -+ RESIDENCE <br /> <br />C COMMERCIAL <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: <br />BUILDING PERMIT # LAND USE APPLICATION # <br />ENGINEER DESIGNED /ALTERNATIVE <br />DESTRUCTION <br />OTHER <br />NUMBER OF EMPLOYEES: <br />SIGNED <br />MINIMiJtj 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 <br /> TITLE der'', l'e/r DATE 3 -- Z--7" <br />a-6 <br />3 /15 4"kd'I -s- <br />Application Accepted By <br />Final Inspection By <br />Character of Soil to Depth of 3 Ft: <br />COMMENTS C.."6".; ,90-3(P -00 2 <br />Employee ID#kApartig4/61 <br />SPE IAL PERMIT -Approved by <br />Pit/Sump Soil Character: <br />Pr-1.40 £-*CI Zj3AriL 120-4ptra- - . <br />-1) ;\ 32) (.4-349-u4 I cer_A*s <br />PE <br />Code <br />SC <br />INFO <br />Received <br />By., <br />he' <br />ash <br />Amount <br />Remitted Date Permit/ <br />Service Request # Invoice # Permit ID# <br />4-0/d /(S- ap----- //7 /2 „pc°. f22 WW1