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WATER TABLE DEPTH: 3D - () <br />PERC TEST # <br />TYPE OF WORK: NEW INSTALLATION <br />REPLACEMENT <br />ft GEOGRAPHICAL INFORMATION: Coordinates X <br />BUILDING PERMIT # a003ing LAND USE APPLICATION # <br />REPAIR/ADDITION <br /> <br />ENGINEER DESIGNED /ALTERNATIVE <br />OUT-OF-SERVICE SEPTIC SYSTEM <br /> <br />DESTRUCTION <br />DISTANCE TO NEAREST WELL <br /> ft FOUNDATION ft PROPERTY LINE <br />SEEPAGE PITS NUMBER <br /> WIDTH ft DEPTH <br />DISTANCE TO NEAREST WELL ft FOUNDATION IOW ft PROPERTY LINE <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 80 I -r- Urn e.- Re,,f).____crryizi, c ocii . (4- . <br />CROSS STREET 1::>a V I. c Roa d APN oks-DS-13 PARCEL SIZE LI 1 I --) <br />OWNER NAME DO blo iil .5 mol t 4 Orr' oi nd L Ls. cl 7R PHONE <br />/ <br />OWNER ADDRESS Pp 60)( i 'Cler CITY/STATE/ZIP I/N.J 3-oci L i !rise 9.s.-;.5-67 <br />CONTRACTOR Ce0-1-ea I Vet 1Z.v. Se t714 c . PHONE c2 0 q — 362 CY — 3 7 <br />CONTRACTOR ADDRESS 3 7 *62 `foci .--/ct ,i4 i (- li-e- a cnvsTATE,zip s-itck-4-0 vi , cif - <br />LICENSE 4-42 0 C-36 OTHER NUMBER 4/S.--OYSIXPIRATION DATE ? - 2/ -07.2. <br /> <br />INSTALLATION WILL SERVE: 0 RESIDENCE <br /> <br />COMMERCIAL OTHER A) 0 I yo are <br /> <br />NUMBER OF LIVING UNITS: <br /> <br />NUMBER OF BEDROOMS: <br /> <br />NUMBER OF EMPLOYEES: :SS:4110(1V 3.LIS CAPACITY 470o <br />CAPACITY <br />DISTANCE TO NEAREST: WELL / C20 / ft FOUNDATION 5 <br />gal # OF COMPARTMENTS <br />gal # OF COMPARTMENTS <br />• <br />ft PROPERTY LINE VP 7 ft <br /> <br />)1( SEPTIC TANK TYPE/MFG <br />GREASE TRAP TYPE/MFG <br />Conceit /Psc <br />LIFT STATION SIZE TYPE OF PUMP PKG TX PLANT 0 SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />X LEACH LINES elkliallIMINNWO # OF LINES LENGTH OF LINES ft <br />DISTANCE TO NEAREST WELL /00 1 ft FOUNDATION pc, ft PROPERTY LINE OW 9 ft <br />FILTER BED WIDTH ft LENGTH ft ft DEPTH <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />MOUNDED WIDTH ft LENGTH <br />ft DEPTH ft <br />ft itoATION gt) i ft PROPERTY NE ilor 'iv ' ft DISTANCE TO NEAREST WELL /i20 ° <br />X SUMPS WIDTH Li 1 ft LENGTH / 0. 1 ft DEPTH I ft <br />DISTANCE TO NEAREST WELL /20 1 ft FOUNDATION /V / ft PROPERTY LINE 9' fl <br />DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br />ft <br />ft <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 />MINIMUM 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PL ASE CALL (209) 953-7697 <br />SIGNED <br /> '9' <br />NEAL <br />Application Accepted By <br />DEPARTMENTIISE NLY <br />Final Inspection By <br /> Date q <br />Character of Soil to Depth of 3 Ft: <br />COMMENTS f1 jr <br />PE <br />Code INFO <br />SC Received <br />An, <br />CahecKWY Amount ' <br />Remitted Date Permit/ <br />Service Requqq# , Invoice # Permit ID# "rash <br />'Ian 11 -7 /..,,-- 2q-431 :Ps-F(1 41.1/1 X.DOS47-51 <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4/14/18 <br />Employee ID# id <br />Date 110 SPECIAL PERMIT - Approved by <br />Pit/Sump Soil Character: <br />Area