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TYPE OF WORK: LI NEW INSTALLATION <br /> REPAIR/ADDITION <br />REPLACEMENT I OUT-OF-SERVICE SEPTIC SYSTEM <br />INSTALLATION WILL SERVE: ESIDENCE <br /> 171 COMMERCIAL , <br />NUMBER OF LIVING UNITS: <br /> NUMBER OF BEDROOMS: Li <br />ENGINEER DESIGNED /ALTERNATIVE <br />DESTRUCTION <br />D OTHER <br />NUMBER OF EMPLOYEES: <br />ft GEOGRAPHICAL INFORMATION: Coordinates X <br />BUILDING PERMIT # 9 Dal oq 2 LAND USE APPLICATION # <br />WATER TABLE DEPTH: <br />PERC TEST # <br />‘." <br />2 ft ft tO <br />4`' <br />ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 -(209) 468-3420 <br />NON-REFUNDABLE PERMIT <br /> CALL 209) 953'69 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED :SSMICKIV 3.1.1S CITY/ZIP <br />PARCEL SIZE 1, <br />PHONE 57t 69/-2 2 /6 <br />CITY/STATE/ZIP r$41-y C4- cS ..s/e-?4t <br />PHONE <br /> CITY/STATE/ZIP <br />EXPIRATION DATE <br />JOB ADDRESS <br />CROSS STREET <br />OWNER NAME <br />OWNER ADDRESS <br />CONTRACTOR OV\)11 <br />CONTRACTOR ADDRESS <br />LICENSE C-42 Doc-36 OTHER NUMBER <br />7L/2 /VS FA/ C., APN 9 ol 3g os-(D. <br />LoPeT <br />I/41 <br />SEPTIC TANK TYPE/MFG <br />GREASE TRAP TYPE/MFG <br />DISTANCE TO NEAREST: WELL <br />LIFT STATION SIZE <br /> <br />TYPE OF PUMP <br />CAPACITY <br />CAPACITY <br />ft FOUNDATION <br />PKG TX PLANT <br />gal # OF COMPARTMENTS <br />gal # OF COMPARTMENTS <br />ft PROPERTY LINE <br /> ft <br />0 SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />DISTANCE TO NEAREST <br /> <br />WIDTH <br />DISTANCE TO NEAREST <br /> <br />WIDTH <br />DISTANCE TO NEAREST <br /> <br />WIDTH <br />DISTANCE TO NEAREST <br />DISPOSAL PONDS WIDTH <br />DISTANCE TO NEAREST <br />SEEPAGE PITS NUMBER <br />DISTANCE TO NEAREST <br />1•••••••011•1•011110111=1111• <br />— LEACH LINES LEACHING CHAMBERS <br />FILTER BED <br />MOUNDED <br />SUMPS <br /> <br />I # OF LINES i LENGTH OF LINES 00 Fr ft <br />WELL /0 ft FOUNDATION /"C ft PROPERTY LINE .7S" Fr ft <br />ft LENGTH ft DEPTH ft <br />WELL ft FOUNDATION ft PROPERTY LINE ft <br />ft LENGTH <br />WELL <br />ft DEPTH ft <br />ft FOUNDATION ft PROPERTY LINE ft <br />ft LENGTH <br /> ft DEPTH ft <br />ft FOUNDATION ft PROPERTY LINE ft <br />ft DEPTH ft <br />ft FOUNDATION ft PROPERTY LINE ft <br /> <br />ft DEPTH ft <br />ft FOUNDATION <br /> ft PROPERTY LINE ft <br />WELL <br />ft LENGTH <br />WELL <br />WIDTH <br />WELL <br />I HEREBY CERTIFY THAT I HAVE PREPARED THI <br />STA <br />APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br />LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br />RAC"' CE NOTICE REQUIRED FOR INSP TIONS - PLEASE CALL (209)953-7697 <br />.11.7 11TLE eiVr- DATE fp/ <br />vsi f)(1) <br />"b. <br />'1;3t9 <br />MINIM 48H <br />SIGNED <br />Fl <br />7)4 <br />e? <br />,Y C,06(4,0 <br />Slc14 DEPARTMENT UfE ONLY AS. Application Accepted By Date //nig Area Employeepk <br />Final Inspection By , Date 3 r2- k 0 SPECIAL PERMIT - ApprovrrIliu. <br />mb <br />Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: ti--0Evivi71:1) <br />COMMENTS Acid/ nor CzrE hedro3M eXpandinj SySiehEt +0 et tevi10 641 /t, 'Tie( / 1 3 2021 <br />*Nat/1%10.4 9u Ai <br /> <br />- C <br />PE <br />Code <br />SC <br />INFO <br />Received <br />B <br />heck# <br />- s <br />Amount <br />Remitted Date Service Request # <br />Permit/ <br />InInvoice/741N °1141411;#r <br />Air <br />1-11O 115 [11 4300 I -15.21 Sk00X31s 73- <br />ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 42-01 <br />4/14/18