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LI LEACH LINES Li LEACHING CHAMBERS DISTANCE TO NEAREST WELL FILTER BED WIDTH ft LENGTH DISTANCE TO NEAREST WELL MOUNDED WIDTH ft LENGTH DISTANCE TO NEAREST WELL SUMPS WIDTH ft LENGTH DISTANCE TO NEAREST WELL CI DISPOSAL PONDS WIDTH ft LENGTH DISTANCE TO NEAREST WELL ft FOUNDATION SEEPAGE PITS NUMBER WIDTH DISTANCE TO NEAREST WELL ft ft ft ft ft ft ft ft ft ft ft ft ft DEPTH ft PROPERTY LINE LIFT STATION SIZE TYPE OF PUMP LENGTH OF LINES ft PROPERTY LINE ft DEPTH ft PROPERTY LINE ft FOUNDATION 0 SAND OIL SEPARATOR (ENCLOSED SYSTEM) PKG TX PLANT # OF LINES ft FOUNDATION ft FOUNDATION ft DEPTH ft PROPERTY LINE ft FOUNDATION ft DEPTH ft PROPERTY LANE ft FOUNDATION ft DEPTH ft PROPERTY LINE 42-01 4/14/18 t911-4fr*': 13M-4-q-21 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT GEOGRAPHICAL INFORMATION: Coordinates X ft WATER TABLE DEPTH: LAND USE APPLICATION # BUILDING PERMIT # NEW INSTALLATION REPLACEMENT TYPE OF WORK: INSTALLATION WILL SERVE: 0 RESIDENCE NUMBER OF LIVING UNITS: OTHER COMMERCIAL NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: 0 PERC TEST # Li LI REPAIR/ADDITION OUT-OF-SERVICE SEPTIC SYSTEM Li ENGINEER DESIGNED //.._TERNATIVE A' DESTRUCTION 1-4 NON-REFUNDABLE PERMIT CALL (209) 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS 550 Sonn Yi /f1,-e- CITY/ZIP - r4 q5-aos-- CROSS STREET -1-ct rdin6. APN I 7a31-11 PARCEL SIZE OWNER IsdE ot) E5 107 . Ptie-C Yre'h 41-( PHONE /405‘6 67 (4.CITY/STATE/ZIP q5- 3?)-- OWNER ADDRESS 173 7 i l t -)<CCC) Wa7 ( Div )1 PHONE CITY/STATE/ZIP EXPIRATION DATE CONTRACTOR CONTRACTOR ADDRESS LICENSE DC-42 0 DC-36 OTHER NUMBER ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAzELToN AVENUE - STOCKTON CA 95205 -(209) 468-3420 :SS311C1(1V 311S SIGNED 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. 48 HOU ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209)953-7697 MINIMU DATE TITLE PE Code SC INFO Received By I Checkt# Cash Amount Remitted Date Permit/ Service Request # Invoice # Permit ID# LJ3a 1 075- 07--6( Viei- PS-.)- 10.4 21 W DI)gL-ILI \ .1 ft CAPACITY CAPACITY ft FOUNDATION OCT -417- eat° 2 61 aft 202, Date Date DEPARTMENT US ONLY 11 lb I 2-1 )0,3 Pit/Sump Soil Character: mledt <ev ,ler. SEPTIC TANK TYPE/MFG LI GREASE TRAP TYPE/MFG DISTANCE TO NEAREST: WELL gal # OF COMPARTMENTS gal # OF COMPARTMENTS ft PROPERTY LINE A4M,, QUA, 71:(tni:4t4tECUAfTY Area VS 41:j:4-°/9 Employee lD 0 SPECIAL PERMIT -Approved by Application Accepted By Final Inspection By A , Character of Soil to Depth of 3 Ft: COMMENTS