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CITY/ZIP y-eALA_A <br />49'170(, oaLi <br />CITY/STATE/ZIP <br />PHONE <br />k ‘t---c_dl <br />r,209 Lig() (Ac) <br />LICENSE DC-42 0 DC-36 OTHER EXPIRATION DATE NUMBER <br />WATER TABLE DEPTH: CO —70 ft GEOGRAPHICAL INFORMATION: Coordinates X <br />BUILDING PERMIT # )qo SCOG LAND USE APPLICATION # <br />Li REPAIR/ADDITION Li ENGINEER DESIGNED /ALTERNATIVE <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 />TYPE OF WORK: .pt NEW INSTALLATION <br />Li REPLACEMENT Li OUT-OF-SERVICE SEPTIC SYSTEM Li DESTRUCTION <br />0 PERC TEST # <br />92./D <br />rc_1\-i-AkA - <br />N\c,LA Y1 <br />OWNER ADDRESS C??., <br />CONTRACTOR <br />CONTRACTOR ADDRESS <br />PHONE C I CD Lio 3t) <br />CITY/STATE/ZIP <br />JOB ADDRESS <br />CROSS STREET <br />OWNER NAME <br />APN PARCEL SIZE I CI 7 <br />c(2 J <br />r <br />13141(Mga,... <br />NESCei bil oi <br />ItIAR 0 1 0, <br />2 <br />ARI1C4111g <br />ilek ri.;VOANEN UAlry <br />DePARTAI <br />1.1 <br />SAN :SSalICICIV 3IIS <br />INSTALLATION WILL SERVE: RESIDENCE <br /> E COMMERCIAL <br /> OTHER <br /> <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: Ci\ <br />NUMBER OF EMPLOYEES: <br />341 SEPTIC TANK TYPE/MFG R))//1,1(,)be"14 CAPACITY iC00 gal # OF COMPARTMENTS £2 <br />GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS <br />DISTANCE TO NEAREST: WELL )30 ft FOUNDATION ft PROPERTY LINE f. ft <br />LIFT STATION SIZE <br /> TYPE OF PUMP <br /> CI PKG TX PLANT CI SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />kr LEACH LINES 0 LEACHING CHAMBERS # OF LINES LI LENGTH OF LiNEs ?.S--- ft <br />DISTANCE TO NEAREST WELL )0 0 ft FOUNDATION 10 + ft PROPERTY LINE S- * ft <br />FILTER BED WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />MOUNDED WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />SUMPS WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE 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 />N5 MI M 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 95377697 <br />SIGNED P _cl„..?,150_97; ie• a____c TITLE 0 vti rer DATE _V / ie.90 <br />4 <br />DEPARTMENT SE ONLY <br /> Area Employee ID# 2_ Date ec/q q , A S ......--7- z 8/ l id _..„, <br />Date t-i ( 5t1 Z, ( _ El SPECIAL PERMIT - Approved by <br />Pi Sump Soil Character: <br />Ir NelAl ,-C:Fg Cec-ond residence, <br />rvil 4 ir a scliess q a716.. 1-e4<ii )1*-.5 ck ppro Ve'S t.eiSed 0/7 pei C -frsf • <br />PE <br />Code <br />SC Received Check#/ <br />Cash <br />Amount <br />Remitted <br />Date <br />Permit/ <br />Service Request # <br />Invoice # Permit ID# <br /> 1) 7 <br />INFO Bi <br />d V1_ i 5,____ t 5il R 3-1-22 S2.0(3 gLiq32._ <br />_ <br />42-01 <br />4/14/18 <br />131 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />Application Accepted By <br />Final Inspection By <br />Character of Soil to Depth of 3 Ft: <br />COMMENTS /\)on Repc43( c y