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INSTALLATION WILL SERVE: A. RESIDENCE NUMBER OF LIVING UNITS: COMMERCIAL NUMBER OF BEDROOMS: OTHER NUMBER OF EMPLOYEES: 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 WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X TYPE OF WORK: PERC TEST # NEW INSTALLATION REPLACEMENT ENGINEER DESIGNED /ALTERNATIVE DESTRUCTION X. REPAIR/ADDITION OUT-OF-SERVICE SEPTIC SYSTEM BUILDING PERMIT # LAND USE APPLICATION # OWNER ADDRESS CONTRACTOR Serb Sea tit lzo eoete CONTRACTOR ADDRESS Po „S61 CITY/STATE/ZIP LICENSE C-42 C-36 OTHER ” A" NUMBER 1068208 EXPIRATION DATE 8-31-22 JOB ADDRESS CROSS STREET OWNER NAME 15717 14 Cu ii-ay kr c l Ijy Lev ra.,-(64cpay APN C CIOVDO L.. P PARCEL SIZE (7., 9.' PHONE-3V '/38 —la??? CITY/ZIPLi9 Cf; PHONE — e-03 — 5 —q CITY/STATE/ZIP A)1 tiii500 CA TS-44i$ SEEPAGE PITS NUMBER WIDTH WELL /..5"..0 DISTANCE TO NEAREST Final Inspection By Character of Soil to Dept 98 3 Ft: COMMENTS OnCiekr)vilielea her Application Accepted By/ A., SEPTIC TANK GREASE TRAP LIFT STATION TYPE/MFG CAPACITY . TYPE/MFG CAPACITY DISTANCE TO NEAREST: WELL ft FOUNDATION SIZE TYPE OF PUMP PKG TX PLANT gal # OF COMPARTMENTS gal # OF COMPARTMENTS ft PROPERTY LINE ft LI SAND OIL SEPARATOR (ENCLOSED SYSTEM) )1, LEACH LINES LEACHING CHAMBERS # OF LINES I DISTANCE TO NEAREST WELL .j ft FILTER BED WIDTH ft LENGTFI DISTANCE TO NEAREST WELL Li MOUNDED WIDTH ft LENGTH DISTANCE TO NEAREST WELL LI SUMPS WIDTH ft LENGTH DISTANCE TO NEAREST WELL LI DISPOSAL PONDS WIDTH ft LENGTH '1' FOUNDATION /0 ft PROPERTY LINE DISTANCE TO NEAREST WELL ft LENGTH OF LINES ft ft ft ft ft ft ft ft ft ft ft ft ft DEPTH ft FOUNDATION ft PROPERTY LINE ft DEPTH ft FOUNDATION ft PROPERTY LINE ft DEPTH ft FOUNDATION ft PROPERTY LINE ft DEPTH FOUNDATION ft PROPERTY LINE ft DEPTH ft FOUNDATION /0 ft PROPERTY LINE AO 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. MINIMUM 41 JR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209)953-7697 Z TITLE 14444 DATE S-13 -- Z_ Aer eJ eg- DEPARTMENT USE ONLY Sigir Area 11/ Date C/Ci Employee ID# Date ( SPE IAL PERMIT - Approved by Pit/SumpSoil Character: If Ale'-.1 let: hoe nix,/ p r Second PE Code SC INFO Received CheckiN C8S Amount Remitted -Date Permit/ Service uest # Invoice # Permit ID# `10)10 IIS— ( if Ai 1 -t -so 0-2C- P:-00 r12- 42-01 4/14/18 &i)qJ z_224-14- ONSITE WASTEWATER TRTMNT SYSTEM PERMIT SIGNED F