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WATER TABLE DEPTH: Ci ° ) °° ft GEOGRAPHICAL INFORMATION: Coordinates X <br />PERC TEST BUILDING PERMIT # <br /> <br />LAND USE APPLICATION # <br />Area SIC76; Employee ID# As <br />0 SPECIAL PERMIT - Approved by <br />Sump Soil Character: <br />cL C/eiri n e vve 11 3F-,e61 1,4e i tD E i the <br />t <br />Application Accepted B <br />Final Inspection By <br />Character of Soil to Depth of 3 Ft: a <br />COMMENTS P-e iDt 0 <br />110f tlecs-i- c s:r (t,r. )- N.; .1.1 <br />PE <br />Code <br />SC <br />INFO <br />Received (.....?p#P) Amount <br />Remitted Date Permit/ <br />Service Request 9 Invoice # Permit 109 ash <br />1-13 JD li S- (- <br />e <br />j 7 D 1 4-&.) Lk -7 Zi <br />42-01 <br /> <br />ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4114/18 <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 />JOB ADDRESS ,[7:.‘"5d 4Z CITY/ZIP /,WC •ff <br />CROSS STREET:&1_' e_1621_4e/i1e APN 02H8 1 <br /> <br />PARCEL SIZE c-) <br />OWNER NAME /Ce7,(' je.ex'of-- PHONE 24, fi /ix /407 <br />OWNER ADDRESS <br /> <br />CITY/STATE/Zip <br />CONTRACTOR ,/ f/.6 xe7et1 PHONE Zoi' if2Y - <br />CONTRACTOR ADDRESS f.7-{7 /(162-17 Orr/STATE/Zip ,47 i,71-57zw <br />LICENSE C C-42 0.1(C-36 OTHER NUMBER 1 LOO 4613 EXPIRATION DATE <br />TYPE OF WORK: NEW INSTALLATION II REPAIR/ADDITION <br />REPLACEMENT JI C/(.' ICI OUT-OF-SERVICE SEPTIC SYSTEM <br />L ENGINEER DESIGNED /ALTERNATIVE <br />E DESTRUCTION <br />INSTALLATION WILL SERVE: r3--- RESIDENCE <br />NUMBER OF LIVING UNITS: <br />0 COMMERCZL <br />NUMBER OF BEDROOMS: / <br />0 OTHER <br />NUMBER OF EMPLOYEES: <br />SEPTIC TANK TYPE/MFG CAPACITY gal # OF COMPARTMENTS <br />GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS <br />DISTANCE TO NEAREST: WELL ft FOUNDATION <br /> ft PROPERTY LINE ft <br />LIFT STATION SIZE TYPE OF PUMP PKG TX PLANT CI SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />LEACH LINES LEACHING CHAMBERS <br /> <br /># OF LINES LENGTH OF LINES ft <br /> <br />, DISTANCE TQ,,EAREST WELL <br />" " <br />,ft , FOUNDATION ft PROPERTY LINE ft <br />/ <br /> <br />ti FILTER BED WIDTH ...:- ft LENGTH ft DEPTH _...n- 4' ft <br />DISTANCE TO NEAREST WELL -5'0 ft FOUNDATION /__C/ ft PROPERTY LINE /''..- / ft <br />MOUNDED WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />SUMPS WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> <br />ID DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION <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 />tifINJMUM 48/V2DVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (2091953-7697 <br />. 4,1z, TITLE, DATE '.4/-1:" 7i2 i <br />ft PROPERTY LINE ft <br />Ak• <br />P,4 ), <br />Cee iik"4/ <br />4p4) <br />204 4 2 4. dal <br />jt-144/1 le‘a/VC 7;9 <br />4jCP <br />Nip Ot6v, <br />Altit. 417 <br />447