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WATER TABLE DEPTH: <br />I PERC TEST # <br />1] OTHER <br />NUMBER OF EMPLOYEES: <br />COMMERCIAL <br />) UMBER OF BEDROOMS: <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 3C) 1Z 41,t CITY/ZIP (-04 (-4- <br />CROSS STREET APN PARCEL SIZE <br />OWNER NAME <br />CITY/STATE/ZIP <br />CONTRACTOR et9 Mk/ i VI 14y •C PHONE (20 9 — .i&el" -57;9 7 <br />CONTRACTOR ADDRESS 39 Lk, 4-r e aik Dr. Crry/STATE/ZIP --ClOck-A44, <br />NUMBER 17159‘,K-EXpIRATION DATE q/3°/'3 <br />osioo21 <br />AA; 4.-e o.s+ it, el ci <br />PHONE <br />OWNER ADDRESS SCI141 <br />LICENSE I: -N-42 Li C-36 OTHER :SSIMUIVILlS ft GEOGRAPHICAL INFORMATION: Coordinates X <br />BUILDING PERMIT # 910c ‘.'? 1 LAND USE APPLICATION # <br />REPAIRTION <br /> <br />ENGINEER DESIGNED (ALTERNATIVE <br />DESTRUCTION <br /> <br />OUT-OF-SERVICE SEPTIC SYSTEM <br /> <br />TYPE OF WORK: NEW INSTALLATION <br />REPLACEMENT <br /> <br />INSTALLATION WILL SERVE: RESIDENCE <br /> <br />NUMBER OF LIVING UNITS: <br />SEPTIC TANK TYPE/MFG 6.mo1eje 6c, :51-7 Yli CAPACITY gal # OF COMPARTMENTS <br />0 GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS <br />DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br />LIFT STATION SIZE TYPE OF PUMP 0 PKG TX PLANT 0 SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />X # OF LINES 0 ) 620 1 ft LEACH LINES LEACHING CHAMBERS LENGTH OF LINES <br />DISTANCE TO NEAREST WELL dOO ' it— it FOUNDATION 20 ' ft .. PROPERTY LINE 70 1 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 C? ) WIDTH 3Ce "t:76— i ft ft DEPTH <br />DISTANCE TO NEAREST WELL ...1x:+4 ft FOUNDATION (YO ' ft PROPERTY LINE I5 ' ft <br />I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN <br />JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br />CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br />WORKERS COMPENSATION LAWS. <br />MINIMUM 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209)953-7697 <br />SIGNED 0 TITLE 7_4(th& DATE /0 7,2 <br />PAYMEST <br />RECEIVED <br />95 zo27 <br />InktNVESq.jifopti C:tAUFIrYE.NT <br />HEA-111 — <br />ocl <br />...--,,,, .e...-. <br /> DEPARTMENI0TLIW2SONLY <br />Application Accepted B i . . <br />Final Inspection By , U. 3 3/C , ,,-; I. Date I OA IWZ L D SPECIAL PERMIT -Approved by <br />I.. <br />Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br />COMMENTS eigf My) repr "ner U. EX pe i nS iDr1 6-C 51,Srir 9/ SOYs. 45 (411ed 1Cr <br />SrPik rAprk TD,,,..tiLLf;,,, ri n iy e r _512 ooPl 8.2 6 . <br />PE <br />Code <br />SC <br />INFO <br />Received <br />ByA <br />Check#/ Amount <br />Remitted Date Permit/ <br />Service Request # Invoice # Permit ID# <br />'PIO Hs" ,,62/ <br />y <br />(rift , <br />110' 22 Sa 00 ggi 2 <br />4201. ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />Area qiaei Employee ID# FcA?Ik <br />5/5/17