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CONTRACTOR \ <br />OWNER ADDRESS L <br />NS 1" bne.:friI43E 1 <br />4.1 CITY/STATE/ZIP <br />COMMERCIAL <br /> <br />INSTALLATION WILL SERVE: )1Z) RESIDENCE <br /> <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS:_ <br />NON-REFUNDABLE PERMIT <br />Joe ADDRESS 921) 1'4 4r— itx•S".; <br />CROSS STREET APR CC( 30 40 PARCEL SIZE 7 <br />OWNER NAME \v"4 PHONE Bb7 Z.S6 <br />CITYISTATEJZIP <br />PHONE '2 7 3 411/4q3?7-119'2-- <br />CONTRACTOR AD DREsf, Wt.; %X <br />LICENSE LI C-4:2 CC-SE OTHER A NUMBER &'tL1 EXPIRATION DATE <br />Lo1 CA. 0)Sa 4/3 <br />Z..) 01 <br />CALL (209) 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />L Ot. (-Ps S <br />WATER TABLE DEPTH: 5 Ii GEOGRAPHICAL INFORMATION: Coordinates X <br />LC PERC TEST 4 BUILDING PERMIT # LAND USE APPLICATION # <br />-TYPE OF WORK: LC NEW INSTALLATION REPAIR/ADDITION C ENGINEER DESIGNEE) /ALTERNATIVE <br />REPLACEMENT 5 DESTRUCTION <br />OTHER <br />NUMBER OF EMPLOYEES: 3 <br />ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1863 East Haztetion Avenue - STOCKTON CA 95205-6232• (209) 468-3420 <br />SEPTIC TANK TYPE/MFG ,ey45 CAPACITY gal 4 OF COMPARTMENT'S <br />CI GREASE TRAP TYPE/MFE CAPACITY gal 4 OF COMPARTMENTS <br />DISTANCE TO NEAREST: WEI ft FOUNDATION ft PROPERTY LINE ft <br />LIFT STATION SIZE TYPE OF PUMP 0 PEW TX PLANT 0 SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />LEACH LINES 5/ LEACHING CHAMBERS I NO. III '‘.14 f :It OF LINES ALL. LENGTH OF LINES LID ' ft <br />DISTANCE TO NEAREST WELL I 03 '''. ft FOUNDATION 10 .ft PROPERTY LINE 5,‘ 4 ft <br />FILTER BED Mom ft LENGTH ft DEPTH It <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It <br />MOUNDED WIDTH ft LENGTH , DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE ft <br />SUMPS WIDTH it LENGTh II DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />O DISPOSAL PONDS WIDTH t., ft LENGTH It DEPTH ft <br />DISTANCE TO NEAREST WELL ftFOUNDATION t PROPERTY LINE ft <br />5,-SEEPAGE PITS NUMBER lo 2. IphoTH ft DEPTH 2..<, ' ft <br />DISTANCE TO NEAREST WELL IISQ:1 I 0 e ft FOUNDATION c 1 ft PROPERTY LINE S ' .1- It <br /> —, <br />!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 />MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS -PLEASE CALL (209)953-7693 i <br />SIGNED TITLE ...4. LS i 0 Cis••"1 DATE hAlf ( ''' <br />_9 ovcIllr4i3 Data l'2@ I Are.] _41.11._ Employee IDg c2Q ath <br />DEPARTMENT USE 0Nr <br />Final Inspection B 1. 4 TWO " Dote 51/ZeVia _ SPECIAL PERMIT .Approved by <br />Character of Soil to • .pth of 3 Ft: Pit/Sump Soil Character: <br />COMMENTS • OA. <br />PE <br />Code <br />SC <br />INFO <br />Received <br />13 <br />(thec Amount <br />Remitted D te Permit/ <br />Service Re • uest Invoice # Permit ID41. <br />EIS <br />42o u5 <br />Application Acce <br />Of/SITE WASTEWATER TRTMNT SYSTEM PERMIT 42-01 <br />C,A/ST