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u <br />ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 <br />JOB ADDRESS <br />CROSS STREET <br />Crrv/ZIP/ 7 <br />L( (t�U T_ /i� <br />APIN L/ i 3 a 5 V o PARCEL SIZE L/ <br />OWNER NAMEN- 1- r- PHONE <br />OWNER ADDRESS Pb n O 7( �- y O c(/ CITY/STATE/ZIP� W d br <br />CONTRACTOR i PHONE C;10.9 <br />CONTRACTOR ADDRESS <br />Z9-3 4, D M. /-;L- • CfTY/STATE/ZIP <br />LICENSE "t-42 C-36 OTHER NUMBER 4(5�90 EXPIRATION DATE <br />�AI.�.. T.... �•l�r.w.. O' 1 N l���wn.n. e.... I..m..... �.�... /.......il....•..' V V <br />PERC TEST I BUILDING PERMIT # LAND USE APPLICATION # <br />TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE <br />REPLACEMENT OUT-OFSERVICE SEPTIC SYSTEM DESTRUCTION <br />INSTALLATION WILL SERVE: RESIDENCE COMMERCIAL OTHER _ <br />NUMBER OF LIVING UMTS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br />LI SEPTICTANK TYPE/MFG Ca!'"6 CAPACITY 981 # OF COMPARTMENTS <br />❑ GREASETRAP TYPE(MFG CAPACITY y 981 #OFCOMPARTMENTS)) <br />DISTANCETO NEAREST: WELL ft FOUNDATION ®o' ft PROPERTY LINE Jd ft <br />❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />424/12 <br />PE SC Received <br />h <br />Amount Date <br />Permit/ Invoice # Permit ID# <br />Code INFO <br />Cash <br />Remlfted <br />■ r r r <br />a ■ . <br />1122-44,qS' <br />J I <br />0�dl <br />• <br />r <br />%■■■■■■■al►#'.tU■■ <br />aas�l■■�:.■■■■I!?�■!w■■■/iIlRlaiw■■ <br />■■■■ <br />�J■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ <br />,R1 5 2018 <br />■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■w. <br />,.QUIN COUNTY <br />-• <br />. i.: .•• <br />LTH DEPARTMENT- <br />�r <br />Date 7Z �4 SPECIAL PERMIT - Approved by <br />CPII)Sump Sol] Character: <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />424/12 <br />PE SC Received <br />h <br />Amount Date <br />Permit/ Invoice # Permit ID# <br />Code INFO <br />Cash <br />Remlfted <br />Service Request # <br />�71L45 <br />1122-44,qS' <br />J I <br />0�dl <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />424/12 <br />