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TYPE OF WORK: I 1 <br />I I <br />(oockele /AL SEPTIC TANK TYPE/MFG <br />GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS <br />El LIFT STATION SIZE PKG TX PLANT CI SAND OIL SEPARATOR (ENCLOSED SYSTEM) TYPE OF PUMP <br />CITY/STATE/ZIP <br />CAPACITY /200 gal # OF COMPARTMENTS <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 />JOB ADDRESS 148 fp/ 6 pat/ sPet_ci-rdzip tad , <br />CROSS STREET ce, Pi APN 0150 1101/4 PARCEL SIZE q.7 I <br />OWNER NAME ROCIle 1 )e, Cikt d Dr0141C1 kine PHONE <br />WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X <br />0 PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # <br />7(1 REPAIR/ADDITION NEW INSTALLATION <br />REPLACEMENT OUT -OF-SERVICE SEPTIC SYSTEM )tDESTRUCTION septiz t-4 0 <br />INSTALLATION WILL SERVE: Kg' RESIDENCE <br />ENGINEER DESIGNED /ALTERNAy <br />E COMMERCIAL OTHER <br />er <br />NUMBER OF LIVING UNITS: I NUMBER OF BEDROOMS: ik-8/4)044 NUMBER OF EMPLOYEES: <br />DISTANCE TO NEAREST: WELL /do ft FOUNDATION ft PROPERTY LINE _5"-o ft <br />OWNER ADDRESS R 0 )3 'V 163 0 <br />CONTRACTOR 6,14)111 Lig Se,6t <br />3 LI W4.1. 4-61-1 c _TATE.ZIP SfrePA3, (-4 CONTRACTOR ADDRESS _ITY. <br />LICENSE 4-42 LC-36 OTHER NUMBER VS-9.01/5— EXPIRATION DATE <br />34-9— .50,2 7 PHONE <br />PAY MENT <br />WED REC-E <br />JUL 2 6 2022 <br />J <br />-SAN- <br />EALTH <br />EN VIP <br />JOAZ <br />ON <br />DEPAR iNtENT <br />11 <br />MENTAL <br />N COUNTY <br />X1r. LEACH LINES il LEACHING CHAMBERS # OF LINES (/) <br /> LENGTH OF L1NEs ii? P ft <br />DISTANCE TO NEAREST WELL / 30 1 ft FOUNDATION _le ' ft PROPERTY LINE 5-6 ' 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 ate ft LENGTH /c9 i ft DEPTH /0 ' ft <br />DISTANCE TO NEAREST WELL / 5-0 ' 4— ft FOUNDATION 4'0 ' ft PROPERTY LINE 5-0 ' 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 ft FOUNDATION ft PROPERTY LINE ft WELL <br />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 />MINIMUM 48 HOUR ADVANCE NQVCE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 <br />SIGNED TITLE tipst— DATE SS3HUOV 3 IIS DEPARTMENT UE ONLY <br /> Date --)/d 4/RD Area ‘ilqg Employee ID# NA <br />Date 7-24---z-t_ 0 SPECIAL PERMIT - Approved by <br />Character of Soil to Depth of 3 t•... Pit/Sump Soil Character: <br />COMMENTS iriFe OnGleifftvlineaf 're, It, Lxis .)-0,5 lInes r ) be cf bc,ncloned. <br />syslem ar or CCeSSorr 51-1 0Chn'e., <br />PE <br />Code <br />SC <br />INFO <br />Received <br />B <br />Check#/ <br />Cash <br />Amount <br />Remitted Date Permit/ <br />Service Request # Invoice # Permit ID# <br />(jaw Ns- <br />1,_______2_ <br />Lisql4 4-31a i.z(,-2askoogsGg-2_ <br />ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />Application Accepted By <br />Final Inspection By <br />42-01 <br />4/14/18