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JOB ADDRESS 5'! 1-1/clAwelY 3 Crre/Zip 17?,9Gy <br />CROSS STREET <br /> j4J y c? <br /> <br />APN S S JgOOS— PARCEL SIZE I <br />OWNER NAME 11.ieGY66 'J )1 AltnytilcA PqKcpa 5 PHONE qc41•2:1 -qt°2- <br />OWNER ADDRESS ?A-1g 27_. Mi/Vkv\in 33 CITY/STATE/ZIP 1 l'r4( cm- 1S39u/ <br />CONTRACTOR Orsiner- <br />PHONE <br />CONTRACTOR ADDRESS C ITY/S TATE/ZIP <br />LICENSE 0 oC-42 00C-36 OTHER NUMBER EXPIRATION DATE <br />INSTALLATION WILL SERVE: <br />NUMBER OF LIVING UNITS: <br />X RESIDENCE D COMMERCIAL <br />NUMBER OF BEDROOMS: 3 D OTHER <br />NUMBER OF EMPLOYEES: <br />ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCK-roN CA 95205 -(209) 468-3420 <br />NON-REFUNDABLE PERMIT CALL (209) 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />WATER TABLE DEPTH: <br />0 PERC TEST # <br />ft GEOGRAPHICAL INFORMATION: Coordinates X <br />BUILDING PERMIT # <br /> <br />LAND USE APPLICATION # <br />TYPE OF WORK: Cl NEW INSTALLATION <br />itc, REPLACEMENT f Ark <br />REPAIR/ADDITION Li ENGINEER DESIGNED /ALTERNATIVE <br />OUT-OF-SERVICE SEPTIC SYSTEM A DESTRUCTION }G: 11 k <br />Id SEPTIC TANK <br /> <br />TYPE/MFG 163D 041 SCIA-/ Craftlg- Zlettti p <br />CAPACITY 1530 <br />gal # OF COMPARTMENTS 2. <br />LI GREASE TRAP <br /> <br />TYPE/MFG CAPACITY gal # OF COMPARTMENTS <br />DISTANCE TO NEAREST: WELL lit ft FOUNDATION 2.6 ft PROPERTY LINE I 5 ft <br />LIFT STATION SIZE TYPE OF PUMP 0 PKG 'Of PLANT 0 SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />LEACH LINES 0 LEACHING CHAMBERS. # OF LINES LENGTH OF LINES ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />FILTER BED WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />CI MOUNDED WIDTH It 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 It <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 />MINIMUM 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209)95 -7697 <br />SIGNED —WO 1,/f) TITLE 0 WA/ FP DATE '-- <br />I <br />.0,•••••- <br />fAVA5 <br /> <br /> <br /> <br />ft <br />Dee IfSC471t0)71°47‘ <br />PA <br />z+24 <br />Mfarely <br />DEPARTMENT USE ONLY <br />rAs.7. Application Accepted By •-•,---.....Z ,e-:•-' Date Id P7/7 ) Area s-/q6) Employee lo# <br />Final Inspection By Pt , Aa---"----- Date ‘ 2.-Vt.fia 2.4 o SPECIAL PERMIT - Approved by <br />Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br />COMMENTS 1-Gok repLitehieni v4 jilavt pv ,n, '4. D-0,b1e re- Vef.ry th 4 t f:44,,e,h'S Ootif f ele <br />linfut orh trvq..s-re tql4L nii,si meet se 11,0,,i< -to CGOicii. 30 Got sp t64( L. L.J011)d <br />/ <br />PE <br />Code <br />SC <br />INFO <br />Received <br />By <br />Ch <br />4.1:210 <br />Amount <br />Remitted ate PermIt/ <br />Service Request # Invoice # Permit ID# <br />LNI 0 IIC r i , • ' ' i 3.° Li. <br />r <br /> -1 A g2c-f-614LAI I <br /> 9qq,-1 nii , 'i Mr— 4 3v0 <br />ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />bit4(1440( <br />344) JoAQ <br />f" C‘i ito 1 is I Yltd <br />42-01 <br />4/14/18