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OWNER ADDRESS <br /> <br />CITY/STATE/ZIP <br />LICENSE 0 C-42 ODC-36 OTHER 44-. NUMBER (7 dI8S-S-1-4 EXPIRATION DATE D'Ojf-X <br />JOB ADDRESS <br />CROSS STREET <br />OWNER NAME <br />ne_l so() <br />HUA/r <br />cavizip S-Fac.4416,n (-A /511C <br />APN <br /> <br />PARCEL SIZE 3 , kt7 <br />PHONE <br />4) 4(1610-e, 5er <br />eo 41(5K (5) <br />CONTRACTOR <br />CONTRACTOR ADDRESS <br />PHONE <br />CITY/STATE/ZIP <br />00" WATER TABLE DEPTH: <br />TYPE OF WORK: INSTALLATION <br />REPLACEMENT 2, <br />INSTALLATION WILL SERVE: LI--4ESIDENCE E COMMERCIAL <br />NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br />LI OTHER <br />BUILDING PERMIT # <br />1...."ZREPAiR/APPiTioN <br />OUT-OF-SERVICE SEPTIC SYSTEM <br />I I ENGINEER DESIGNED /ALTERNATIV <br />DESTRUCTION 1:91.4, <br />PERC TEST # LAND USE APPLICATION # <br />ft GEOGRAPHICAL INFORMATION: Coordinates X <br />NUMBER OF LIVING UNITS: <br />EPARTMENT ONL Y <br />Area Employee ID# • &O 011011 <br />Z—ALI SPECIAL PERMIT -Approved by <br />Pit/Sump Soil Character: Character of Soil to Depth of 3 Ft: e Pos3 <br />o-6e-No COMMENTS (R..c.,,V.,_:tA4 5 futmiLIUG) <br />Application Accepted By <br />Final Inspection By <br />PE <br />Code <br />SC <br />INFO <br />Received Check <br />s ._ <br />Amount <br />Remitted Date, Permit/ <br />Service Request # Invoice # Permit ID# <br />4Z( 0 ( 1 . 3.2.,?iL , 13.0 S 24)1M e.-- SPA373 > <br />ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />Date <br />Date <br />42-01 <br />4/14/18 <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 />GK-SEPTIC TANK <br />TYPE/MFG tad 1- CAPACITY I ZYN gal # OF COMPARTMENTS (A <br />GREASE TRAP <br />TYPE/MFG CAPACITY gal # OF COMPARTMENTS <br />DISTANCE TO NEAREST: WELL 103 ft FOUNDATION WS ) ft PROPERTY LINE <br /> ft <br />LIFT STATION SIZE TYPE OF PUMP PKG TX PLANT ID SAND OIL SEPARATOR (ENCLOSED SYSTEM) :Scat! (lay 311S i7LEACH LINES <br />FILTER BED <br />MOUNDED <br />SUMPS <br />DISPOSAL POND <br />la-1E-EPAGE PITS <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE <br />WIDTH ft LENGTH ft DEPTH <br /> <br />ft DEPTH <br />ft PROPERTY LINE <br />ft DEPTH .9S <br />ft PROPERTY LINE Ito' <br />DISTANCE TO NEAREST WELL ft PROPERTY LINE ft FOUNDATION <br />S WIDTH ft LENGTH <br />DISTANCE TO NEAREST WELL ft FOUNDATION <br />NUMBER D" WIDTH Ii <br />DISTANCE TO NEAREST WELL 5.43 ft FOUNDATION I O4- <br />LEACHING CHAMBERS <br /> <br /># OF LINES <br /> <br />LENGTH OF LINES 65 <br />DISTANCE TO NEAREST WELL Oa) <br /> <br />ft FOUNDATION 1461 ft PROPERTY LINE 56 I <br />WIDTH <br /> <br />ft LENGTH ft DEPTH <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE <br />WIDTH ft LENGTH ft DEPTH <br />ft <br />ft <br />ft <br />ft <br />ft <br />ft <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 />SIGNED <br />MINIMUM 48 HOURa DVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209)953-7697 <br /> 114" <br />TITLE •••1:511.i- IN cAtri— re DATE S.1...0))..." <br />/ <br /> 1?E*C.,/frLtf t <br />y " <br /> <br />11 PO') <br />-.417 ), <br />47'