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LAND USE APPLICATION # BUILDING PERMIT # 0 PERC TEST # REPAIR/ADDITION I I ENGINEER DESIGNED /ALTERNATIVE OUT-OF-SERVICE SEPTIC SYSTEM X DESTRUCTION 4-.01111< El COMMERCIAL , 4r" NUMBER OF BEDROOMS: Pd V iff,31-dS E OTHER NUMBER OF EMPLOYEES: TYPE OF WORK: L NEW INSTALLATION ?f\ REPLACEMENT + 0 INSTALLATION WILL SERVE: X RESIDENCE NUMBER OF LIVING UNITS: (e=id Li , 44-64/ )11s -..•••••• 2 - 3 I I —171:171-TH —r ,‘ ENT ED 5 202i MAI 2 RECEIV \O' BAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH 1.:EPARTIMIT 2 40, ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAzELToN AVENUE - STocKTON CA 95205 -(209) 468-3420 NON-REFUNDABLE PERMIT CALL (209) 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED 000 — n qZ.1,1, IN Q7. Aa.: CI CITY/ZIP Th,i\C--1() ( -k 304 &ve.f6yeevi APN ir01/113)-7 PARCEL SIZE Gie-on c 6cime CITY/STATE/ZIP JOB ADDRESS CROSS STREET OWNER NAME PHONE OWNER ADDRESS a A CONTRACTOR 5geniz- Cor1.5 tru&-ri 0 n PHONE CONTRACTOR ADDRESS ,?7,13 ?arta! ce._ CITY/STATE/ZIPTE/zi, q LICENSE LIG-42 _IC-36 OTHER (11) NUMBER c12.5 7 E 0 5 3 O CI EXPIRATION DATE ,w7 Dock- (Li 72.5 WATER TABLE DEPTH: if-35 /Iwo ID ft GEOGRAPHICAL INFORMATION: Coordinates X SEPTIC TANK TYPE/MFG CAPACITY )__00 gal # OF COMPARTMENTS GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft LIFT STATION SIZE TYPE OF PUMP PKG TX PLANT 0 SAND OIL SEPARATOR (ENCLOSED SYSTEM) LEACH LINES I I LEACHING CHAMBERS # OF LINES LENGTH OF LINES ft DISTANCE TOptEAREST WELL ft FOUNDATION ft PROPERTY LINE ft FILTER BED WIDTH 1- -' ft LENGTH 37- ft DEPTH t,.' 1-1 C4e--titt 0 Ill a? ft DISTANCE TO NEAREST WELL ft FOUNDATION 10 1 1,-).-5 ft PROPERTY LINE II) -'%J3 ft MOUNDED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft SUMPS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft SEEPAGE PITS NUMBER WIDTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft 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. MINI tHOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209)953-7697 SIGNED TITLE DATE DEPARTMENT US ONLY Date _1- s." / Date E SPECIAL PERMIT - Approved by Pit/Sump Soil Character: 604 4/at -foil 0 Vri s-oo 0-2 )/y, rZ t•-% PE Code SC INFO Received y Check#/ Cash Amount Remitted Date Permit/ Service Request # Invoice # Permit ID# 9 d 10 -- 11 ipp U .A3°1`) 4jI V-0,013.9qt 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT Application Accepted Final Inspection By rit, Character of Soil to Depth of 3 Ft: COMMENTS F 1 I yv, .s ys irw (id apiet Area Employee ID# As :SS311UUV 311S 4/14/18