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ft FOUNDATION ft PROPERTY LINE ft WELL <br />f-A) <br />Al0114 <br />Character of Soil t epth of 3 <br />i COMMENTS (-C-42.-- -0,0 gni trek <br />(21 OA <br />Soil Character: <br />Application Accepted <br />Final Inspection By T...1Z)L SP IAL PERMIT - Approved by <br />EPAR rMEN7JJsf ONLY <br />ate La" 7/43 Area 4ft 74 Employee I CI(MA4:70401 <br />cf-A <br />723/zo 2 <br />0344-61). ti.4/4-Alg <br />ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - SroctrrON CA 95205 - (209)468-3420 <br />NON-REFUNDABLE PERMIT <br />JOB ADDRESS <br />CALL 2r) 953-769 ' FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />3 C <br />CROSS STREET o APN PARCEL SIZE 7 • g <br />OWNER NAME <br />CITY/STATE/ZIP <br />L. PHONE <br />CONTRACTOR ADDRESS <br /> <br />CITY/STATE/ZIP <br /> <br />LJCENSE C-42 C-36 OTHER NUMBER EXPIRATION DATE <br /> <br />WATER TABLE DEPTH: 1,,U <br />n 1 <br />ft GEOGRAPHICAL INFORMATION: Coordinates X lirpg <br />11 PERC TEST # BUILDING PERMIT # [ 70 1-1475 1CND USE APPLICATION It <br />TYPE OF WORK: NEW INSTALLATION REPAJRIADDIT1ON ENGINEER DESIGNED /ALTERNATIVE <br /> <br />INSTALLATION WILL SERVE: )r.,FIESIDENCE COMMERCIAL_6 <br /> <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: <br />REPLACEME OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br />NUMBER OF EMPLOYEES: <br />OTHER <br />OWNER ADDRESS <br />CONTRACTOR LO <br />PHONE <br />j1'1 CV <br />r7 Gy <br />SEPTIC TANK TYPE/MFG CAPACITY li C( (...) C gal <br />GREASE TRAP TYPE/MFG CAPACITY gal 4 OF COMPARTMENTS t <br />DISTANCE TO NEAREST: WELL t 03 -1- ft FOUNDATION (44- ft PROPERTY LINE ....t ft <br />CI LIFT STATION SIZE CI PKG TX PLANT CI SAND OIL SEPARATOR (ENCLOSED SYSTM <br />7 -C-, <br />LEACH LINES LEACHING CHAMBERS # OF LINES 0 LENGTH OF LINES I ft <br />DISTANCE TO NEAREST WELL ( 00 4" ft FOUNDATION It 01 *If ft PROPERTY LIN ft <br />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 DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />SUMPS WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />CI DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />LI SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br />.1 # OF COMPARTMENTS <br />TYPE OF PUMP <br />DISTANCE TO NEAREST <br />HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br />TATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br />*TICE REQUIRED FORMSPECTIONS - PLEASE CALL (209)953 <br />TITLE _ DATE A 2 :SNANUOV 31IS I-2AF> t.6 e <br />/•• <br /> RE <br />PA <br />- )(MEN' -Cep, 7- <br />If Et) <br />114..4:. m CO1, <br /> eiv 44:5A/Oilv. <br />UN7 <br />i <br />' 1,, 6 2020 - ..Ar),,,, <br />' 1)P4,4,7.7ilt . r <br />(t- i 1101±PP <br />LI 72-12- i <br />PE SC <br />.INFO <br />Received <br />,W <br />Checkrt/ <br />Cast' <br />Amount <br />emitted <br />I Date Permit/ <br />Service Regliest # Invoice # Permit ID# <br />07 <br />.4edi-t- 19 ,frli.i., , "5 POO -S 6C/ <br />42-01 <br />4/14/18 1 /633 32— ONSITE WASTEWATER TRTMNT SYSTEM PERMIT