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EN7 . nes° <br /> 202; <br /> <br />84714A,uhv co„ <br />ER4 <br />MEAT <br />Employee ID# <br />1.1 <br /> <br />ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE -STocKTON CA 95205 -(209) 468-3420 <br />NON-REFUNDABLE PERMIT CALL (209) 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />JOB ADDRESS 1 °t c5 C,--<- r "614 err\ v.)-(,—e— CITY/ZIP At f°0(1 /C* <br />CROSS STREET YO Se An I' i'e.. APN ; it 4.- 3 e) -3 I PARCEL SIZE 02. <br />OWNER NAME ni; ( /161 E. I ) A 1)5.S6, gere2 c, PHONE ;S31111UV 31IS OWNER ADDRESS C/13 trissil on R;d5e D f CITY/STATE/ZIP <br />CONTRACTOR 1/1/1/t zrc- S-er. PHONE <br />al 4 fcce. <br />CONTRACTOR CONTRACTOR ADDRESS 6<va 6 CITY/STATE/ZIP ‘4/1-• <br />LICENSE El LC-42 El DC-36 OTHER <br /> A- NUMBER (0) .--5-3.-Z11 EXPIRATION DATE ar, <br />WATER TABLE DEPTH: LI 0 - ft <br /> <br />GEOGRAPHICAL INFORMATION: Coordinates X <br />PERC TEST # BUILDING PERMIT # 00 j s LAND USE APPLICATION # <br />TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION I I ENGINEER DESIGNED /ALTERNATIVE <br />REPLACEMENT ii OUT-OF-SERVICE SEPTIC SYSTEM I I DESTRUCTION <br /> <br />INSTALLATION WILL SERVE: <br /> <br />liCr*IrtESIDENCE <br /> <br />MBER OF LIVING UNITS: <br /> <br />0 COMMERCIAL E OTHER <br />NUMBER OF BEDROOMS: 11 NUMBER OF EMPLOYEES: <br />g'0Z51:-.)- gal SEPTIC TANK TYPE/MFG <br /> P <br />CAPACITY <br />GREASE TRAP TYPE/MFG <br />DISTANCE TO NEAREST: WELL (00 1 ft FOUNDATION 1 61 <br /> <br />ft <br />LIFT STATION SIZE TYPE OF PUMP <br /> <br />PKG TX PLANT ID SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />LEACH LINES LEACHING CHAMBERS <br />DISTANCE TO NEAREST WELL <br />FILTER BED WIDTH D•D I ft LENGTH <br />DISTANCE TO NEAREST WELL t15-61 ft FOUNDATION <br /> <br />I <br />MOUNDED WIDTH ft LENGTH <br />DISTANCE TO NEAREST WELL ft FOUNDATION <br />SUMPS WIDTH ft LENGTH <br />DISTANCE TO NEAREST WELL ft FOUNDATION <br />DISPOSAL PONDS WIDTH ft LENGTH <br />DISTANCE TO NEAREST WELL ft FOUNDATION <br />SEEPAGE PITS NUMBER WIDTH <br />DISTANCE TO NEAREST WELL ft FOUNDATION <br /> <br />ft PROPERTY LINE <br /> ft <br />I 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 /># OF COMPARTMENTS <br />CAPACITY gal # OF COMPARTMENTS <br />PROPERTY LINE Lt 0 ft <br /># OF LINES LENGTH OF LINES ft <br />ft FOUNDATION ft PROPERTY LINE ft <br />ft DEPTH if ft <br />ft PROPERTY LINE ft <br />ft DEPTH ft <br />ft PROPERTY LINE ft <br /> ft DEPTH ft <br />ft PROPERTY LINE ft <br />ft DEPTH ft <br />ft PROPERTY LINE ft <br />ft DEPTH ft <br />N# <br />MINIMUM 48 I-10U - Am NCE NOTICE RE UIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 <br /> TITLE CO-1("ti..A 0-c-r-c\r- DATE 1 UP &I SIGNED <br />e-- A-1 _1 <br />DEPARTMENT SE ONLY <br /> Date q AA? 1 Area 9/ q <br />Date 2 \ 0 SPECIAL PERMIT - Approved by <br />Pit/hump Soil Character: <br />1--#1e r L Per SSA)1., 1 06 rees(-:Of nk p4 6 <br />I <br />Application Accepted <br />Final Inspection By <br />Character of Soil to Depth of 3 Ft: <br />COMMENTS Nev\I FP • <br />fou r ilz) six Irctie_s carrpo/ pecif for re Ikr bQrl <br />PE <br />Code <br />SC <br />INFO <br />Received 6.ecktr/ Amount <br />Remitted Date Permit/ <br />Service Request # Invoice # Permit ID# <br />i'l a 1 1 117 <br />;isy)...i Ahbri <br />:9 f ? LI 1144 CRP° VF9-1(1 <br />ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 42-01 <br />4/14/18