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IL hed <br />42-01 <br />4/14/18 <br />ONSITE WASTEWATER TRTMNT SYSTEM PERMIT CW 4 /1 -7 /OD <br />E PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # <br />LICENSE 0 C-42 Lit i C-36 OTHER NUMBER EXPIRATION DATE <br />ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 -(209) 468-3420 <br />CALL (209) 953-7697 FOR INSPECTIONS <br />„o e 3 6 kl Ad lbe,r-k Av. <br />NON-REFUNDABLE PERMIT <br />CONTRACTOR ADDRESS <br />CONTRACTOR <br />JOB ADDRESS CITY/ZIP f....,koc qs-62.1 <br />CROSS STREET r }- APN I7 31-131C-1 PARCEL SIZE / <br />OWNER NAME VI AO \//eO7qU7 <br />OWNER ADDRESS 3C U. Met be A- Ave. <br />0 t j vV <br />PHONE (20q) 3-361 <br />ciTyisTATE/zip kce o4 CA qc. 13- <br />PHONE <br />CITY/STATE/ZIP <br />EXPIRES 1 YEAR FROM DATE ISSUED <br />WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X <br />TYPE OF WORK: I I <br />I <br />NEW INSTALLATION <br />REPLACEMENT <br />REPAIR/ADDITION <br />OUT-OF-SERVICE SEPTIC SYSTEM <br />INSTALLATION WILL SERVE: C RESIDENCE <br />NUMBER OF LIVING UNITS: <br />II COMMERCIAL <br />NUMBER OF BEDROOMS: <br />0 <br />0 <br />0 <br />SEPTIC TANK <br />GREASE TRAP <br />LIFT STATION <br />TYPE/MFG CAPACITY <br />TYPE/MFG CAPACITY <br />DISTANCE TO NEAREST: <br />SIZE TYPE <br />WELL ft FOUNDATION <br />OF PUMP 0 PKG TX PLANT 0 <br />0 <br />0 <br />0 <br />LEACH LINES <br />FILTER BED <br />MOUNDED <br />SUMPS <br />DISPOSAL PONDS <br />SEEPAGE PITS <br />LEACHING CHAMBERS <br />DISTANCE TO NEAREST <br />WIDTH <br /># OF LINES <br />WELL <br />ft <br />ft FOUNDATION <br />LENGTH <br />DISTANCE TO NEAREST <br />WIDTH <br />WELL <br />ft <br />ft FOUNDATION <br />LENGTH ft <br />DISTANCE TO NEAREST <br />WIDTH <br />WELL <br />ft <br />ft FOUNDATION <br />LENGTH ft <br />DISTANCE TO NEAREST <br />WIDTH <br />WELL <br />ft <br />ft FOUNDATION <br />LENGTH ft <br />DISTANCE TO NEAREST <br />NUMBER <br />WELL ft FOUNDATION <br />WIDTH <br />DISTANCE TO NEAREST WELL ft FOUNDATION <br />DA <br /> Date 2_ 1-31-27 C SPECIAL PERMIT - Approved by <br />Character of Soil to Depth of 3,Ft: it/Sump Soil Character: <br />COMMENTS C,orrieasri,3 <frvve-K <br />PE <br />Code <br />SC <br />INFO <br />Received <br />By., <br />Check#/ <br />Cash <br />Amount <br />Remitted Date Permit/ <br />S rvice Request # Invoice # Permit ID# <br />93,A1 07s 6/ilk--, ,b,ST-± 0 ,, df./ It IIII: S OVOtt <br />DEPARTMENT U E ONLY <br />Application Accepted By Date 11/17 0700 Area a/ -7 'I Employee ID# <br />Final Inspection By <br />I I ENGINEER DESIGNED /ALTERNATIVE <br />4 DESTRUCTION < H3Yi V1 <br />C OTHER <br />NUMBER OF EMPLOYEES: <br />gal # OF COMPARTMENTS <br />gal # OF COMPARTMENTS <br />ft PROPERTY LINE <br />SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />ft <br />LENGTH OF LINES ft <br />P441 yA,„ ft PROPERTY LINE ft <br />ft PROPERTY LINE --civt ft <br />DEPTH <br />Ceti <br />ike0 ft <br />DEPTH ft <br />ft PROPERTY LINE ft <br />ft DEPTH ft <br />ft PROPERTY LINE ft <br />ft DEPTH <br />ft PROPERTE <br />11101/ <br />7 ft <br />QC/hv DEPTH ft <br />ft PROPE OCO ft