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OWNER ADDRESS 1M CITY/STATE/LP CONTRACTOR \NigSt ritiSk 12/1.hor ,C., PHONE 7_0ct CONTRACTOR ADDRESS '3 1•46qC4J \ \--• CITY/STATE/ZIP C P 2c-1-22-1C; LICENSE E - C-42 = -C-36 OTHER A NUMBER ,cS5I tr51 EXPIRATION DATE DISTANCE TO NEAREST: WELL CAPACITY ft FOUNDATION ft GEOGRAPHICAL INFORMATION: Coordinates X BUILDING PERMIT # LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION REPLACEMENT REPAIRJADDMON OUT-OF-SERVICE SEPTIC SYSTEM IT ENGINEER DESIGNED /ALTERNATIVE DESTRUCTION OTHER 3 NUMBER OF EMPLOYEES: 7 COMMERCIAL NUMBER OF BEDROOMS: INSTALLATION WILL SERVE: X RESIDENCE NUMBER OF LIVING UNITS: TYPE/MFG TYPE/MFG CAPACITY V' SEPTIC TANK GREASE TRAP LIFT STATION SIZE TYPE OF PUMP U PKG TX PLANT ft CI SAND OIL SEPARATOR (ENCLOSED SYSTEM) WATER TABLE DEPTH: PERC TEST # gal # OF COMPARTMENTS gal if OF COMPARTMENTS ft PROPERTY LINE CITY/ZIP APN On7 3d 00 PARCEL SIZE PHONE PAYm Sp 10 2020 CIA :U:7 TAuLN Ty kw-rk,o/l s.4 EN HEA ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA95205 - (209) 468-3420 NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS 04 5-7 CROSS STREET cm,cp cv e, OWNER NAME DISTANCE TO NEAREST WELLt -'...:1-D -15--- ft FOUNDATION FILTER BED WIDTH ft LENGTH ft DISTANCE TO NEAREST WELL ft FOUNDATION MOUNDED WIDTH ft LENGTH DISTANCE TO NEAREST WELL ft FOUNDATION SUMPS WIDTH ft LENGTH DISTANCE TO NEAREST WELL ft FOUNDATION DISPOSAL PONDS WIDTH ft LENGTH DISTANCE TO NEAREST WELL ft FOUNDATION 4 SEEPAGE PITS NUMBER I WIDTH 3 (0 )) DISTANCE TO NEAREST WELL I SC ft FOUNDATION _ . . I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. SIGNED 0, ( k 44.A.-1-1 Vi e,7 MINI\ UM 48 OUR AD AN FE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209)953-7697 ,O TITLE .-M y'd er..:Cf&I\ CLki DATE CI \ ?)n ., 1 - i LEACH LINES k LEACHING CHAMBERS (C\ \ tY0. t S # OF LINES t 0,- LENGTH OF LINES ft ft PROPERTY LINE ft DEPTH ft ft PROPERTY LINE ft ft DEPTH ft ft PROPERTY LINE ft ft DEPTH ft ft PROPERTY LINE ft ft DEPTH ft ft PROPERTY LINE ft ft DEPTH ft ft PROPERTY LINE 5.-r- ft :SS:THaaV 31IS RTMENT ONLY Date q Date 2- -1- \ 7 SPECIAL PERMIT -Approved by wsump Soil Character: / )7,5 1*. 0 aria sWebn. DEPA PE Code SC INFO Received Check#/ Cash Amount Remitted Date Permit/ Service Request # Invoice # Permit 113# tP I ti ) IS- ?i,lb. /4 (fietzfit 4 .C, 0 '111‘)/A) S Pk G"-I i 42-01 4/14/18 P3y92:74/-F ONSITE WASTEWATER TRTMNT SYSTEM PERMIT Application Accepted By 4i •-• Final Inspection By Character of Soil to Depth of 3 Ft: COMMENTS ys-frkvi s 4i-hi 4 •cai • OkaY per. pfaire44^1 kora o ID 020'10 Area Employee ID# DA