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EXPIRES 1 YEAR FROM DATE ISSUED NON-REFUNDABLE PERMIT CALL (209)953-7697 FOR INSPECTIONS <br />?-77 stiz 7714‘24,,,,t , JOB ADDRESS <br />CROSS STREET GeAmeAn, APN 00)1, 3. PARCEL SIZE <br />PHONE — <br />WATER TABLE DEPTH: less tk41 ac) GEOGRAPHICAL INFORMATION: Coordinates X • ft <br />OWNER NAME St64.4,1) /ye <br />OWNER ADDRESS z6 067, 77isez 4-3.10 CITY/STATE/ZIP 111t9-(2.41:900 <br />CONTRACTOR _._5!!gif!ja‘e,z4k,,,c_e,/1/21,4.a _ PHONE q -7 Cs - 67,51' <br />CONTRACTOR ADDRESS CITY/STATE/Zip kv1I7,, <br />LICENSE D DC-42 DOC-36 !OTHER NUMBER i Z..e. C./ XXPIRAIION DATE <br />VOSci)=. Log <br />—7oz -7 :ss3tinev 3.us In <br />ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STocicroN CA 95206 - (209)468-3420 <br />0 PERC TEST # <br />[INSTALLATION WILL SERVE: <br />BUILDING PERMIT # LAND USE APPLICATION # <br />IT REPAIR/ADDITION <br />A OTHER At+ ::/yr" jl Wit <br />NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br />TYPE OF WORK: .1‘,„ NEW INSTALLATION <br />0 REPLACEMENT <br />LI ENGINEER DESIGNED /ALTERNATIVE <br />0 OUT-OF-SERVICE SEPTIC SYSTEM II; DESTRUCTION <br />NUMBER OF LIVING UNITS: <br />RESIDENCE 0 COMMERCIAL <br /> <br />X SEPTIC TANK TYPE/MFG $5 L.. Tleherk. <br />LI GREASE TRAP TYPE/MFG <br />DISTANCE TO NEAREST: WELL <br />LIFT STATION SIZE TYPE OF PUMP <br />CAPACITY a0c, kiggi gal # OF COMPARTMENTS Z <br />CAPACITY gal # OF COMPARTMENTS <br />FOUNDATION + I PROPERTY LINE IC) r ft <br />PKG TX PLANT U SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />PIA ft <br />LEACH LINES 0 LEACHING CHAMBERS <br /> <br /># OF LINES 3 LENGTH OF LINES / 1,0 L ft <br /> <br />DISTANCE TO NEAREST WELL /19/Aft FOUNDATION <br /> I 45" 4-• ft PROPERTY LINE 10 ft <br />C3 FILTER BED WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />MOUNDED WIDTH ft LENGTH ft <br /> <br />DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />SUMPS WIDTH ft LENGTH ft <br /> <br />DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE <br />C3 DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE <br />CI SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />1 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 HaeDVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 <br /> TITLE v r DATE I ZQ-c. <br />MEM OM • MN ME M MN m mmmmmmmmmm mamma omm mmummom mm mommummommummommum mommommummummommmummImmimmmummummummu <br />11111111111111111111111111111911 <br />II <br />mommummugsrammmmumum mummummmimmrilmm <br />iiiiiiiiiiiiiiiiiiiiiiim 11111111111111141 <br />11111111 MP III I ammilmammimmimmi lim 111111111116111111 • mom mom mum • • mum mourn m mm <br />OEPARTME, SE ONLY <br />Date // dOaC) <br />17 <br />Date b 1,11 V2 1 ) 0 SPECIAL PERMIT - Approved by <br />Character of Soil to Depth of 3 Ft? -'c ...0T-A- Pit/Sump Soil Character: <br />COMMENTS for 34017 c rovAnAtt shah) ,t3)-re) t..) I th kP-7303s-st $iesied tbcli buildin <br />Sid nj 112 ,.0 serivl A y 5÷7v1. RA211(__ Wolfer, <br />PE <br />Code <br />SC <br />INFO <br />Received <br />VPre h <br />Amount <br />f Remitted Date „ <br />Permit/ <br />Service Request # Invoice 4/ Permit IOU <br />90 p7 1124.41102, *S----1-79-- iiiip-o SP-0052. <br />ft <br />ft <br />ft <br />Application Accepte <br />Final Inspection By <br />Area 9 Employee !DI 1)4 <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />411018