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CI OTHER <br />NUMBER OF EMPLOYEES: 3 NUMBER OF BEDROOMS: <br />Ll COMMERCIAL <br />ft LI LEACH LINES LEACHING CHAMBERS # OF LINES 3 LENGTH OF LINES <br />LAND USE APPLICATION # BUILDING PERMIT # <br />REPAIR/ADD1TION Li ENGINEER DESIGNED /ALTERNATIVE TYPE OF WORK: NEW INSTALLATION <br />I:1 REPLACEMENT <br />LIFT STATION 0 PKG TX PLANT 0 SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />TYPE/MFG CAPACITY /rq 06 gal # OF COMPARTMENTS <br />TYPE/MFG CAPACITY gal 4 OF COMPARTMENTS <br />DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE <br />SEPTIC TANK <br />GREASE TRAP <br />SIZE TYPE OF PUMP <br /> <br />WATER TABLE DEPTH: ( ft <br /> <br />PERC TEST IA <br />OUT-OF-SERVICE SEPTIC SYSTEM 0 DESTRUCTION <br />ft <br />GEOGRAPHICAL INFORMATION: Coordinates X <br /> <br />INSTALLATION WILL SERVE: k RESIDENCE <br /> <br />NUMBER OF LIVING UNITS: / <br />UIRED FOR INSP <br />TITLE <br />I NS - PLEASE CALL 209 953-7697 <br />DATE <br />HOUR 4 D 1NCE NOTICE RE MINI <br />SIGNED <br />ft PROPERTY LINE ft WELL ft FOUNDATION <br />ft LENGTH ft DEPTH ft <br />WELL ft FOUNDATION ft PROPERTY .4y11 ft <br />ft LENGTH ft DEPTH —'T>:.-T7--- ft <br />WELL (COCY ft FOUNDATION ( SC/ -/- ft PROPERTY LINE ( 74- ft <br />ft LENGTH ft DEPTH ft <br />ft LENGTH ft DEPTH ft <br />WELL ft FOUNDATION ft • - PROPERTY LINE ft <br />WELL ft FOUNDATION ft PROPERTY LINE ft <br />WIDTH ft DEPTH ft <br />ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. I.-IAZELTON 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 ,2C 5' _g? /---/a4 se.A fiz ciTylz,, roc V <br />CROSS STREET APN i "/ <br />( <br />,re99:'-ca • PARCEL SIZE <br />OWNER NAME i M C / / i ,9/ 0 //r( 61r) i )/4--S tiAC-:E PHONE <br />OWNER ADDRESS 7/ / i acc.a. Ci CITY/STATE/ZIP Fr. fi7D(..14 <br />CONTRACTOR Iti€r1-- Pfunt, a ,,,c( LA— PHONE <br />CONTRACTOR ADDRESS &-t )35 <br />LICENSE E LC-42 C-36 OTHER NUMBER FS-6.9'N EXPIRATION DATE <br />cW9‘ <br />CITY/STATE/ZIP /11/0darte-S(0 <br />DISTANCE TO NEAREST <br />FILTER BE Q WIDTH 0'0 <br />I 2-00 DISTANCE TO NEAREST <br />MOUNDED WIDTH <br />DISTANCE TO NEAREST <br />SUMPS WIDTH <br />DISTANCE TO NEAREST <br />DISPOSAL PONDS WIDTH <br />DISTANCE TO NEAREST <br />SEEPAGE PITS NUMBER <br />DISTANCE TO NEAREST WELL <br /> <br />ft FOUNDATION <br /> <br />ft PROPERTY LINE ft <br /> <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 />fv:r4 <br />'411Z Ii‘:j 1:?tE.CP <br />. <br />All. 41 I <br />sky <br />9 <br />co <br />'•,€-Nr <br />2071 <br />UN7 ii _iicttio/iv <br />joA <br />D°'•4 /771,LIt 1 <br />1A <br />i...1A,DE )PARTMENTIUSEI44.Y PO <br />I <br />Final Inspection By , ( <br />Character of Soil toeptribf 3 Ft: 7p <br />COMMENTS f6e.-0, (//0 le\ j <br />'-'"w LIIr <br />Date Li 0 SPECIAL PERMIT -Approved by <br />Pit/Sun p Soil Character: <br />v777k <br />PE <br />Code <br />SC <br />INFO,„-- <br />Received Check#/ <br />ash <br />Amount <br />Remitted dyg <br /> Date Permit/ <br />Service Request # Invoice # Permit ID# <br />0 I _S Vi6c(--- 3 lit iV iiii 5r6b Ncrii , <br />42-01 <br />4/24/12 Y'Sw ONSITE WASTEWATER TRTMNT SYSTEM PERMIT :SSMIUCIV aITS