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PHONE 7_ C79; /4/7 ciTy/sTATEizip S'712,./Wle,./1// C-4.4 CONTRACTOR X 2/427i,,q,7 CONTRACTOR ADDRESS ,142611j1 LICENSE ,..,if0C-42 00C-36 OTHER xi - NUMBER 57:1 02 EXPIRATION DATE /.:„ :20E_ ft GEOGRAPHICAL INFORMATION: Coordinates X 4-0' WATER TABLE DEPTH: LAND USE APPLICATION # BUILDING PERMIT # O REPAIR/ADDITION LI OUT-OF-SERVICE SEPTIC SYSTEM El ENGINEER DESIGNED /ALTERNATIVE X. DESTRUCTION TYPE OF WORK: 0 NEW INSTALLATION REPLACEMENT 0 RESIDENCE INSTALLATION WILL SERVE: NUMBER OF LIVING UNITS: 0 COMMERCIAL NUMBER OF BEDROOMS: 0 OTHER NUMBER OF EMPLOYEES: 3' L )4 SEPTIC TANK TYPE/MFG GREASE TRAP TYPE/MFG DISTANCE TO NEAREST: WELL / LIFT STATION SIZE TYPE OF PUMP 0 PKG TX PLANT CI SAND OIL SEPARATOR (ENCLOSED SYSTEM) 0 to RECE PAYMENT WED L :C 3 2021 Date Date Area 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 PERC TEST # H/ICICIV HIIS CAPACITY /al) V gal # OF COMPARTMENTS CAPACITY gal # OF COMPARTMENTS ,__., i 2 , ft FOUNDATION -") -t' ft PROPERTY LINE $" )- LEACH LINES 0 LEACHING CHAMBERS # OF LINES LENGTH OF LINES , ---.' ) ft DISTANCE TO NEAREST WELL /07 /+ ft FOUNDATION /0/-2' ft PROPERTY LINE - ft FILTER BED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft MOUNDED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft SUMPS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft gt. SEEPAGE PITS NUMBER 2--, WIDTH g,Q, ft DEPTH 9. —C. i ft DISTANCE TO NEAREST WELL hie-il ft FOUNDATION /0 /i-- ft PROPERTY LINE _...... .„._ ft 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. MIN SIGNED M 48 HO,fijIDVANS,,E NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209)953-7697 TITLE DATE /.2 JOAQUIN COUNTY ENV RONMENTAL PARTMENT PARTMENT S ONLY Application Accepted B Final Inspection By Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: COMMENTS -7-1-n--f 71 PE Code SC INFO Received Check#/ Cash.1 Amount Remitted Date y Permit/ Service Request # Invoice # Permit ID# 4z1 0 I / C i) fk..t too,{ 7/0 CO f3611) t i 7 V_ 512. 00SLI GV5 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 42-01 4/14/18 E. AN EALTH DE Employee ID#_cgirier-14 0 SPECIAL PERMIT - Approved by JOB ADDRESS /5-4.,2, 67,21/1/1117- /219 - CROSS STREET 72/./ I/ OWNER NAME /4 A AN toe IA< OWNER ADDRESS cmdzi, 4c...4ff, PO 6,14 APN • - PARCEL SIZE 44. PHONE ‘,(),/i CITY/STATE/ZIP