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NON-REFUNDABLE PERMIT CALL (209) 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 -(209) 468-3420 <br />PHONE (01') c-3792.6 <br />CITY/STATE/ZIP CA 9S-239 • - <br />LAND USE APPLICATION # BUILDING PERMIT # <br />REPAIR/ADDITION 0 ENGINEER DESIGNED /ALTERNATIVE <br />„Se DESTRUCTION REPLACEMENT Joel OUT-OF-SERVICE SEPTIC SYSTEM <br />NEW INSTALLATION TYPE OF WORK: <br />INSTALLATION WILL SERVE: 0 RESIDENCE <br />NUMBER OF LIVING UNITS: <br />0 COMMERCIAL <br />NUMBER OF BEDROOMS: <br />LI OTHER <br />NUMBER OF EMPLOYEES: <br />ft <br />SEPTIC TANK TYPE/MFG CAPACITY gal # OF COMPARTMENTS <br />GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS <br />DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE <br />WATER TABLE DEPTH: <br />LI PERC TEST # <br />ft GEOGRAPHICAL INFORMATION: Coordinates X <br />JOB ADDRESS /09 9 <br />CROSS STREET RC) <br />ciTyizip Lot 4- h Ca 9 ,5•?3c, <br />APN 933 3O4-) PARCEL SIZE I 2- <br />OWNER NAME PHONE <br />OWNER ADDRESS <br />CONTRACTOR C\ y.)--cA I Cie r Cl-{01 r\S 3 PiktAhirly <br />CONTRACTOR ADDRESS rnarl+e Ca. . <br />LICENSE 00C-42 /C-36 OTHER SPilerel A NUMBER 90332g'• EXPIRATION DATE 07- I - 22_ <br />CITY/STATE/ZIP <br />MI 48 HOUR ADVANCE 4WIO7fCE R QUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 <br />SIGN <br />Sitw <br />APR <br />cirpo rii lit AL <br />yme.Air <br /> eiveo <br />8 2022 <br />ov ,, <br />AftAtztvry <br />ARrivid-NT <br />DE PA RTMENT U <br />Application Accepted By <br />3?:)y <br />Date Area , ?-1 Employee ID# <br />/n 5 <br />Final Inspection By Date kl )3 uz_ 11 SPECIAL PERMIT -Approved by <br />Character of Soil to Depth of 3 t. Pit/Sump Soil Character: <br />COMMENTS <br />PE <br />Code <br />SC <br />INFO <br />Received = Amount <br />Remitted Date Permit/ <br />Service Request # Invoice # Permit ID# <br />0 -Z21 0 -7 5 <br />)3(y_._t5,__ <br />d /s-,?.0e) /52 ,I. g- zz . Sk, L)0, (01 <br />ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 42-01 <br />4/14/18 <br />TITLE OCi c DATE 22_ :SSMICICIV ails