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CITY/ZIP ode..1 CROSS STREET API's DO VA b ii?" PARCEL SIZE LI 1, 3 OWNER NAME ZIgivvirApigus ailki&Jeei - :75-citi 0.'0 1' IA) '43=611 Cellti I'S PHONE OWNER ADDRESS fa ei g .1J' arititikri- CITY/STATE/ZIP liCti Mr> el St)9 0 CONTRACTOR ....".., I-4/47 5.' 0.."4-- PHONE CONTRACTOR ADDRESS 37/‘ Xf.....ISICAri.... ,e9"..Ai._ 17,e CITY/STATE/ZIP LICENSE L1p&2 D E C-36 OTHER NUMBER g.5-904":5- EXPIRATION DATE cyz, JOB ADDRESS WATER TABLE DEPTH: s-o - ft GEOGRAPHICAL INFORMATION: Coordinates X (11 VED PAYmk RPco JUL 0 7 SAN HEALTH DFIvpmEN ENviR IN C JoAou AR 2021 OL/ vry TA meNT Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS Arid on b.f . lea' iffici per 5goon73q PE Code SC INFO Received !_y_ (-Ch,s9....VO Lash Amount Date Permit/ Service Request # Invoice # Permit ID# Lials- 357 ulk 214035-- Ren27d 7/- 7 zi 45?1-1 oivietee,-- 35'4 os3 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 42-01 4/14/18 :SS311(1UV 311S ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - S-rocKroN CA 95205 -(209) 468-3420 NON-REFUNDABLE PERMIT CALL (209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED PERC TEST # BUILDING PERMIT # ICIOC i a I LAND USE APPLICATION # 73 TYPE OF WORK: I I NEW INSTALLATION I REPLACEMENT REPAIR/ADDITION OUT-OF-SERVICE SEPTIC SYSTEM ENGINEER DESIGNED /ALTERNATIVE L DESTRUCTION INSTALLATION WILL SERVE: E RESIDENCE NUMBER OF LIVING UNITS: COMMERCIAL NUMBER OF BEDROOMS: E OTHER NUMBER OF EMPLOYEES: See 5R 006 0 SEPTIC TANK 0 GREASE TRAP 0 LIFT STATION TYPE/MFG TYPE/MFG DISTANCE TO NEAREST: SIZE *TYPE WELL ft OF PUMP LEACH LINES LEACHING CHAMBERS DISTANCE TO NEAREST WELL 700 ').-- ft LI FILTER BED WIDTH ft LENGTH DISTANCE TO NEAREST WELL ft LI MOUNDED WIDTH ft LENGTH DISTANCE TO NEAREST WELL ft 0 SUMPS WIDTH ft LENGTH DISTANCE TO NEAREST WELL ft 0 DISPOSAL PONDS WIDTH ft LENGTH DISTANCE TO NEAREST WELL ft PL SEEPAGE PITS NUMBER a.* WIDTH f DISTANCE TO NEAREST WELL Z°°', ft CAPACITY gal # OF COMPARTMENTS CAPACITY gal # OF COMPARTMENTS FOUNDATION ft PROPERTY LINE ft CI PKG TX PLANT ID SAND OIL SEPARATOR (ENCLOSED SYSTEM) # OF LINES r LENGTH OF LINES AO. 1 ft FOUNDATION A,C, ' ft PROPERTY LINE c- i ft ft DEPTH ft FOUNDATION ft PROPERTY LINE ft ft DEPTH ft FOUNDATION ft PROPERTY LINE ft ft DEPTH ft FOUNDATION ft PROPERTY LINE ft ft DEPTH ft FOUNDATION ft PROPERTY LINE ft ft DEPTH ,01.5 ' ft FOUNDATION /5-e ft PROPERTY LINE c ' 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. IN! M 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 SIGNED TITLE C-21.6-Y:Are'G' DATE DEPARTMENT USE ONLY L Date 7/7/2 ) Area Application Accepted By Final Inspection By Employee ID# /411 -ZLO-- Date o-6"-:-2eztE SPECIAL PERMIT -Approved by