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T 1 <br /> jNI-T SY 7 M P E'fT <br /> S1:,N.JOAQUIN COUNTY$NViR0NMEN'/+.L HEALTH DEPA4T�TENT <br /> 1366 E.HAZELTON AVENUE-S TGCKTON CA 95205•(209}4o"8-3Q20 <br /> �I-�I-O-J-l-REFUNDABLE.PERMIT 'CiQf�,2�953_�'697 FOR fNSPcC710NS <br /> �1psl Appl`-,ESS ��Q F � �1 J (EXPIRES I YEAR FROM DATE ISSUED <br /> C?. ICc.0 CITYIZIPi 1� � — <br /> '7 � c. <br /> CROSS STREET " � - /���1 -�------ <br /> APN LI 3,2,�0:� I PARCELSIZE I/So <br /> 6 j <br /> OWNER NAf41E--���� �J <br /> �— _PHONE <br /> OWNER ADDRESS' <br /> — CITY/STATEIZIP <br /> CONTRACTORc!�9L� �� -� <br /> �-' P HOME <br /> CONTRACTOR ADDRESS <br /> -,CITY/STATE/ZIP �j/�flirt,� y�-Zfc7 - <br /> jLICENSE 0I-)<-42 GpC-36 OTHER-- Ntrfv5ER_.���f(J{f� EXPIRATIONDATC— e?21_ <br /> WATER TABLE DEPTH:— � GEGGRAFI ICAL INFORMATMN: Coordinates x <br /> I., <br /> PE TEST ; - Y — <br /> BUILDING(PERMIT* _ .LAND USE APPLICATION <br /> TYPE OF UVO,RIS: D NEW INSTALLATION j� REPAIR/ADD'-T'0N <br /> r' REPLACEP•'IENT �J E'111NEERDESIGNED/AI-TERNATIVE <br /> _ G OUT-Op-SERVICE SEPTIC SYSTEM ❑ DESTFUC('ION <br /> rINSTALLATI N WILLSERVE: RESIDENCE <br /> COMMERCIAL <br /> NL;Pj BER OF LIVING UNITS; OTHER <br /> �=__NUPr18EF.OF BEDROCPAS: NUP.912ER OF EMPLOYEES- <br /> E SEPTIC TANK TYPEIMFG S,[ <br /> —J / !t 7i GArAC;�( ,� _ gal #OF�„C:,-P-.RTfv1ENTS z a GREASE TRAP TvPE!MFG <br /> GA.PACITY gal #OFCOrn•1PAR—MENT5 <br /> DISTANCE TO NEAREST: WELL.— fr FOUNDAT!C 1 <br /> �. LIFT STATION SIZE — --.-- � PROPERTY LING" ft <br /> TYPE OF PUrrTP 0 PKG TX PLANT Z! SAND OIL SEPARATOR(ENCLOSED SYSTEfuI) <br /> LEACH LINES D LEACHING CHAMBERS #OF LINcH � , <br /> LENGTH OF i_fM_.. �_4 <br /> DISTANCETO NEAREST WELL ���� ft FCUNDATION PROPERTY-WE__ S <br /> 8 FILTER BED WIDTH It L=_NGTn-: fi DEPTH <br /> i <br /> DISTANCE TO NE=AREST tiELL ft =OUNDATIOM f PROPERTi"L!NL <br /> UMOUNDEp WIDTH - ft <br /> DISTANCE TONEAREST WELL ft FCJNL'A.TION li PF,O�c.RTYLI:Vr-• it <br /> Q sumps WIDTII t LEKGTH _rt <br /> DISTANCE TO NEAREST 4ELDE=TI <br /> : <br /> 14 <br /> PRCRERTY_it•1- ft <br /> -4 DISPOSAL PONDS WIDTH ft LENGTH _ff D_EDTH ft <br /> DISTANCE TQ NEAREST V:+_LL^ r, FOUNDATION ft =ROPGF,TY L'NE. { <br /> `Z SEEPAGE PITS NUM-GER WIDTH �' ff DEPTH • S' <br /> DISTANCE TG NEAREST WE—L_/ICi`�- f' PCUND.ATIOIt f PROPERTY LINE s— ;t <br /> I,yEREBY CERTIFY'fHAT 1 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. OUR ADDI!'ANCE NOTICE REQUIRED IRED FOR 1 SP,E'MO S-PILEASE GALL (209)953-7/69 <br /> SIGNED TITLE �/r/�" _ DATE <br /> - I I - <br /> �_ <br /> I I I j j <br /> h4_ <br /> Tq AI <br /> 4-1 <br /> /� <br /> DEPARTMENT U E ONLY <br /> Application Accepted B,.--- �z-Z Date q1_711w z10 Area Employee ID#D <br /> Final Inspection By r Date 0 ?DZU ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Pit/SLImp Soil Character: <br /> COMMENTS FU i Iufe 4f j+nP. j ii pr <br /> PE SC Received Check#/ Amount Permit/ <br /> Code INFO B Cash Remitted Date Service Request# Invoice# Permit ID# <br /> La10 il•s 'CSob za 5 Koop196 <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br /> 1 <br />