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ciTymp -r12-A '1 5 3 cz-f- <br />CROSS STREET it4PN -CE7NJ APN Z-01 — '4.0 -0-3- PARCEL SE 14- Ac • <br />OWNER NAME Ai AIJU rnirct-g- <br /> <br />PHONE 5t o - 138 - 3 b 3r) <br /> <br />OWNER ADDRESS 14 7,06 ACD &IA <br />CONTRACTOR <br /> tiE 0 nY-- &Co E-NYI L-Nrrrn._ <br />JOB ADDRESS (0 815. L.). 612-A-N-T E /2-?› • <br />CITY/STATE/ZIP Fe--E-WI (TAST, CA 't39 <br />PHONE <br />CONTRACTOR ADDRESS 44-D3- 1/1/4.) • °Poe— • CITY/STATE/ZIP L01)1 cA <br />LICENSE CIC-42 0.C-36 OTHER <br /> <br />NUMBER EXPIRATION DATE <br /> <br />PERC TEST # <br />TYPE OF WORK: <br />BUILDING PERMIT # LAND USE APPLICATION # <br />0 REPAIR/ADDITION 0 ENGINEER DESIGNED /ALTERNATIVE 0 NEW INSTALLATION <br />LENGTH OF LINES <br />ft PROPERTY LINE <br />DEPTH <br />ft PROPERTY LINE <br />DEPTH <br />ft PROPERTY LINE <br />DEPTH <br />ft PROPERTY LINE <br />ft DEPTH <br />ft PROPERTY LINE <br />DEPTH <br />ft PROPERTY LINE <br />ft <br />ft <br />ft <br />ft <br />ARTMENT SE 0 LY <br />Date <br />Date <br />tN <br />4 <br />Application Accepted By <br />Final Inspection By <br />Character of Soil to Depth of 3 Ft* <br />COMMENTS <br />Area t5,,,k1 Employee ID#A01V <br />SPECIAL PERMIT - Approved by <br />Pit/Sump Soil Character <br />ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET - STOCKTON CA 95202 -(209) 468-3420 <br />NON-REFUNDABLE PERMIT CALL (209) 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />WATER TABLE DEPTH: <br /> ft GEOGRAPHICAL INFORMATION: Coordinates X <br />0 REPLACEMENT 0 DESTRUCTION <br /> <br />INSTALLATION WILL SERVE: E RESIDENCE <br />NUMBER OF LIVING UNITS: <br />0 COMMERCIAL <br />NUMBER OF BEDROOMS: <br />0 <br />0 <br />SEPTIC TANK TYPE/MFG CAPACITY <br />GREASE TRAP TYPE/MPG CAPACITY <br />DISTANCE TO NEAREST: <br />LIFT STATION SIZE TYPE <br />VVELL ft FOUNDATION <br />OF PUMP 0 PKG TX PLANT <br />0 LEACH LINES 0 LEACHING CHAMBERS # OF LINES <br />DISTANCE TO NEAREST WELL ft FOUNDATION <br />0 FILTER BED WIDTH ft LENGTH <br />DISTANCE TO NEAREST WELL ft FOUNDATION <br />0 MOUNDED WIDTH ft LENGTH <br />DISTANCE TO NEAREST WELL ft FOUNDATION <br />0 SUMPS WIDTH ft LENGTH <br />DISTANCE TO NEAREST WELL ft FOUNDATION <br />0 DISPOSAL PONDS WIDTH ft LENGTH <br />DISTANCE TO NEAREST WELL ft FOUNDATION <br />0 SEEPAGE PITS NUMBER WIDTH <br />DISTANCE TO NEAREST WELL ft FOUNDATION <br />0 OTHER <br />NUMBER OF EMPLOYEES: <br />gal # OF COMPARTMENTS <br />gal # OF COMPARTMENTS <br />ft PROPERTY LINE ft <br />0 SAND OIL SEPARATOR (ENCLOSED SYSTEM) <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 />MINIMIJIOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209)953-7697 <br />DATE 3 - 7--// SIGNED , TITLE CA, ").S vt:TA-N1-7 <br />PE <br />Code <br />SC <br />INFO , <br />Received <br />By ash <br />Amount <br />emitted Date Permit/Invoice -Service Request # # Permit ID# <br />a,tre-,/-- /o/ is-2_ ,111),1 s'O,D$0`26/ <br />42-01 <br /> ONSITE WASTEWATER TRTMNT SYSTEM PERMIT