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MOUNDED WIDTH ft LENGTH <br />DISTANCE TO NEAREST WELL <br />SUMPS WIDTH ft LENGTH <br />DISPOSAL PONDS WIDTH ft LENGTH <br />DISTANCE TO NEAREST WELL <br />SEEPAGE PITS NUMBER WIDTH <br />DISTANCE TO NEAREST WELL <br />DISTANCE TO NEAREST WELL ft FOUNDATION <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ft DEPTH ft <br />ft FOUNDATION ft PROPERTY LINE ft <br />ft DEPTH ft <br /> ft PROPERTY LINE ft <br /> ft DEPTH ft <br /> ft PROPERTY LINE ft <br />ft DEPTH ft <br />ft FOUNDATION ft PROPERTY LINE ft <br />ft FOUNDATION <br />M 48 H NOTICE REQUIRED FOR INSPECTIONS - PL EASE CALL (209)953-7697 <br />TITLE '‘ziiztf—ra-f--&--) DATE <br />MINI <br />SIGNED <br />1131117it IN' Ocep,417* <br />41/ve <br />SAN <br />A‹, <br /> vsb <br />4 4702/ <br />4fk• L <br />nrr riff <br />DEPARTMENT U E ONLY <br />Date ///à <br />Date 3( <br />Area Employee ID# <br />0 SPECIAL PERMIT -Approved by <br />- - - Application Accepted By <br />Final Inspection By " Cw L C <br />Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br />COMMENTS be'r00 trE SA:4Z- 1(1 <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 CALL (209) 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />q 3 oF - L.-4.--d (A...4,J 4.---c._ CITY/ZIP <br />---t <br />/ 441i 1 1---on APN J J LI 0 co 7 D PARCEL SIZE <br />12) <br />OWNER ADDRESS 3 crpci F16102 c) <br />CONTRACTOR A__)--w-c <br />CONTRACTOR ADDRESS <br /> 7 17 <br />CITY/STATE/Zip /1.4-, 7 e <br />JOB <br />CROSS STREET <br />OWNER NAME Ce r )1/16 y pi 3. b;e6.0 <br />CITY/STATE/Zip C6 01 pie /1 q.CDO <br />PHONE 2° <br />PHONE :SSHIKKIV TLIS LICENSE EIC-42 0 PC-36 OTHER NUMBER Ry:-Ci 3S''t EXPIRATION DATE <br />WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X <br />0 PERC TEST # BUILDING PERMIT # <br /> <br />LAND USE APPLICATION # <br />REPAIR/ADDITION [I ENGINEER DESIGNED /1_ ?R ATIVE <br />OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION IA <br />TYPE OF WORK: NEW INSTALLATION I I <br />REPLACEMENT Li <br /> <br />INSTALLATION WILL SERVE: LI RESIDENCE <br /> <br />LI COMMERCIAL <br /> <br />LI OTHER <br /> <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br />gr SEPTIC TANK <br /> <br />TYPE/MFG CAPACITY gal # OF COMPARTMENTS <br />GREASE TRAP <br /> <br />TYPE/MFG CAPACITY gal # OF COMPARTMENTS <br />DISTANCE TO NEAREST: WELL ft FOUNDATION <br />ft PROPERTY LINE <br />ft <br />LIFT STATION <br /> <br />SIZE <br /> <br />TYPE OF PUMP U PKG TX PLANT <br />SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />LEACH LINES 111 LEACHING CHAMBERS <br /># OF LINES LENGTH OF LINES ft <br />DISTANCE TO NEAREST WELL <br /> <br />ft FOUNDATION ft PROPERTY LINE ft <br />FILTER BED WIDTH ft LENGTH ft DEPTH ft <br />I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br />AWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br />PE <br />Code <br />SC <br />INFO <br />Received <br />By <br />Ohecldia <br />(.ash <br />Amount <br />Remitted pate Permit/ <br />Service Request # Invoice # Permit ID# <br />I (D7S-- <br />W6 <br />Zlaq .4 is-, 3111 zi Ggo(N -63 2s-- <br />ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 42-01 <br />4/14/18