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JOB ADDRESS i 41 4%. -1 G-fcv.0 -S CROSS STREET .to OWNER NAME 1.) I/ c)r) y SI116 cirdzip 3131; APN c9 a so60 0 6 PARCEL SIZE 'JO Lp PHONE OWNER ADDRESS icioid C0,116, Dr CITY/STATE/ZIP nth, 4 -ietrA CONTRACTOR 44 PHONE 4 Ct.. CONTRACTOR ADDRESS S".:N CITY/STATE/ZIP Cfr LICENSE [11 C-42 01 C-36 OTHER NUMBER S1.-,b5 EXPIRATION DATE LI Application Accepted By Final Inspection By Character - Character of Soil to Depth of 3 Ft: DEPARTMENT USE ONLY Date Area -V C; Employee ID# Date 4/-9 --2/ LI SPECIAL PERMIT - Approved by Pit/Sump Soil Character: ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209)468-3420 NON-REFUNDABLE PERMIT CALL (209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED — WATER TA3LE DEPTH: 10 a 0 ft GEOGRAPHICAL INFORMATION: Coordinates X LI PERC TEST # BUILDING PERMIT LAND USE APPLICATION # TYPE OF WORK: 0 NEW INSTALLATION 1 . REPAIR/ADDITION r! X REPLACEMENT hi ilk 3, i kr„:1 OUT-OF-SERVICE SEPTIC SYSTEM ; ENGINEER DESIGNED /ALTERNATIVE : ;t DESTRUCTION • INSTALLATION WILL SERVE: DENCE C COMMERCIAL LI OTHER UMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: SEPTIC TANK TYPE/MFG CAPACITY gal # OF COMPARTMENTS GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS DISTANCE TO TO NEAREST: WELL 7)5 ft FOUNDATION '`i.) 7 ft PROPERTY LINE 7 .c4 ft LIFT STATION SIZE TYPE OF PUMP 0 PKG TX PLANT SAND OIL SEPARATOR (ENCLOSED SYSTEM) SSJflQy 31IS 1:14:EACH LINES FILTER BED MOUNDED SUMPS DISPOSAL PONDS SEEPAGE PITS DISTANCE TO NEAREST WELL WIDTH DISTANCE TO NEAREST WIDTH DISTANCE TO NEAREST NUMBER DISTANCE TO NEAREST ft t ft FOUNDATION &)S 1 ft PROPERTY LINE (0 . ft ft DEPTH ft ft FOUNDATION ft PROPERTY LINE ft ft DEPTH ft ft FOUNDATION ft PROPERTY LINE ft ft DEPTH ft ft FOUNDATION ft PROPERTY LINE ft ft DEPTH ft ft FOUNDATION ft PROPERTY LINE ft ft ft IT LEACHING CHAMBERS # OF LINES I LENGTH OF LINES ‘75,) 7 DISTANCE TO NEAREST WELL 3,3 ' WIDTH ft LENGTH DISTANCE TO NEAREST WELL WIDTH ft LENGTH ft LENGTH WELL ft LENGTH WELL WIDTH WELL ft FOUNDATION ft PROPERTY LINE ft DEPTH 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. MINIMUM 48 HOU ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209)953- 69 SIGNED TITLE CrIY) tc162-- f-tr DATE 3 &C. 1,4 COMMENTS Fci iiiYI:s Sy -tervi 1:-.),,1owij lior-.5 per Eli b feCo (Clc ( ?/3//31 A meacif d pei pi i'f one wh)-(e. &O' le,;( , 1 he 1-3)--1 6e ,-,) - replo,/h. ;497 - ..,ue ki cetioeicks )(iv de re pi ‘ff.t.' fr1 k /Cif's JioeHn ór ink acideci r. if? ,t 4 L A yi etnS PE Code SC INFO Received By Cateckfil-' Amount _Remitted Date Permit/ Ruest # Invoice # Permit ID#„Arice Cash Li 1 ° I I 5- j6--- /'7S3 *-3DO 11-114 StSaig:771tP)' 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18