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PERC TEST # <br />TYPE OF WORK: <br />BUILDING PERMIT # Oá SO LAND USE APPLICATION # <br />.„P"... REPAIR/ADDITION <br />_ OUT-OF-SERVICE SEPTIC SYSTEM <br />H ENGINEER DESIGNED /ALTERNATIVE <br />DESTRUCTION <br />NEW INSTALLATION <br />REPLACEMENT <br />DISTANCE TO NEAREST WELL /57C7 ft FOUNDATION /6'1 <br /> <br />ft PROPERTY LINE <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 />-7 <br />MINIMpM 48 HOtiR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209)953-7697 <br />SIGNED TITLE -.DATE 3 "/ /2 2-0 '2— I v v <br />ct. Aft ,&„ <br />Afeely 2 ? <br />kip' ("UN OA, Co riy UA, <br />IV 4' 197.„ <br />ct. Aft ,&„ <br />Afeely 2 ? <br />kip' ("UN OA, Co riy UA, <br />IV 4' 197.„ <br />S,44, S,44, <br />fcJ fcJ co.o/ co.o/ <br />Sh) / LIP? q I(A6 <br />DEPARTMENT USE ONLY <br />Application Accepted By Date Area Employee ID# <br />Date kio y 1 -2..1za—\ 0 SPECIAL PERMIT - Approved by <br /> Pit/Sump Soil Character: <br />Sh) / LIP? q I(A6 <br />DEPARTMENT USE ONLY <br />Application Accepted By Date Area Employee ID# <br />Date kio y 1 -2..1za—\ 0 SPECIAL PERMIT - Approved by <br />Pit/Sump Soil Character: <br />COMMENTS Op,A,J S I 4 )th 'lip :"1 (3 1 <br />cal S-Vlo vtp 4 rSIDP per v4 AIVPe rci • • cA4 cuNiz <br />L eat- L D . 5 A.) a <br />COMMENTS Op,A,J SI 4 )th 'lip :"1 (31 <br />cal S-Vlo vtp 4 rSIDP per v4 AIVPe rci• • cA4 cuNiz <br />L eat- L D . 5 A.) a <br />PE <br />Code <br />PE SC SC <br />INFO <br />Received api.,)__ Ch Received Ch Amount Amount <br />Remitted Code INFO api.,)__ Remitted Service Request # Date Permit/ <br />Service Request # Date Permit/ Invoice # Invoice # <br />----I ----I <br />Permit ID# Permit ID# <br />4)O ;is-- 2,5-72- 4)O ;is-- 2,5-72- 4300 *424 Sgt0131-1 4300 *424 Sgt0131-1 <br />ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />Final Inspection By WitlYN Final Inspection By WitlYN <br />ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />Character of Soil to Depth of 3 Ft: Character of Soil to Depth of 3 Ft: <br />'14 '14 <br />42-01 42-01 <br />4/14/18 4/14/18 <br />CONTRACTOR A 6-719 c5> <br />CONTRACTOR CONTRACTOR ADDRESS ,/// em, ) <br />LICENSE EC-42 CC-36 OTHER NUMBER 6q6 "q,o <br />ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />CROSS STREET MCA_ if) <br />OWNER NAME (;) PHONE ;10 " —419".• -2n? <br />OWNER ADDRESS 'f") LA ( CITY/STATE/ZIP 5- 4-4 o A <br />2o9'-? 327j? <br />WATER TABLE DEPTH: 70 —F0 ft GEOGRAPHICAL INFORMATION: Coordinates X <br /> <br />INSTALLATION WILL SERVE: 11 RESIDENCE <br /> <br />E OTHER <br /> <br />NUMBER OF LIVING UNITS: NUMBER OF BEDnboms: ç.J NUMBER OF EMPLOYEES: <br />SEPTIC TANK TYPE/MFG <br /> <br />CAPACITY gal # OF COMPARTMENTS <br />GREASE TRAP TYPE/MFG <br /> <br />CAPACITY gal # OF COMPARTMENTS <br />DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br />LIFT STATION SIZE TYPE OF PUMP PKG TX PLANT 0 SAND OIL SEPARATOR (ENCLOSED SYSTEM) <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 /6 5 .-0 C fj b41 pl,J crryizipi-75-E-e., / 0 (--) c..t, 9-4•--7 2—C) <br />PARCEL SIZE 2.• C)c.<- C-- ApN4--A. Z2.7(70000 .2__ :ssmmay a.us PHONE <br />CITY/STATE/ZIP .1.. -2 _5" <- /10 <br />EXPIRATION DATE