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LAND USE APPLICATION # BUILDING PERMIT # <br />171 TYPE OF WORK: NEW INSTALLATION <br />REPLACEMENT <br />REPAIR/ADDITION <br />OUT-OF-SERVICE SEPTIC SYSTEM <br />I ENGINEER DESIGNED /ALTERNATIVE <br />:X DESTRUCTION /1,11 k <br />NUMBER OF EMPLOYEES: <br />D OTHER 0 COMMERCIAL <br />NUMBER OF BEDROOMS: <br />INSTALLATION WILL SERVE: RESIDENCE <br />NUMBER OF LIVING UNITS: <br />PERC TEST # <br />SEPTIC TANK TYPE/MFG <br />GREASE TRAP TYPE/MFG <br />CAPACITY /,11 0 ,- t. L., gal # OF COMPARTMENTS <br /> CAPACITY gal # OF COMPARTMENTS <br />ft FOUNDATION ft PROPERTY LINE <br />LIFT STATION SIZE TYPE OF PUMP PKG TX PLANT 0 SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />DISTANCE TO NEAREST: WELL <br />/) 4 <br />ft <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 i7 CITY/Z IP (../L,A./ely) <br /> APN R°I <br />OWNER NAM .,'"...',,hS49-79,/, /47 <br />CROSS STREET PARCEL SIZE <br />PHONE --zelzi <br />OWNER ADDRESS CITY/STATE/ZIP <br />CONTRACTOR / //Mr f.).11 qi C - PHONE q(7i <br />CONTRACTOR ADDRESS CITY/STATE/ZIP <br />LICENSE D E C-42 I1C-36 OTHER NUMBER c EXPIRATION DATE <br />WATER TABLE DEPTH: <br /> <br />ft GEOGRAPHICAL INFORMATION: Coordinates X <br /> <br />LEACH LINES <br /> <br />LEACHING CHAMBERS # OF LINES /../ LENGTH OF LINES 4o <br />DISTANCE TO NEAREST WELL <br />1 ft <br />061 ft FOUNDATION 1 01 I- ft PROPERTY LINE ft 5 I t <br />FILTER BED WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />MOUNDED WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />DEPTH SUMPS WIDTH ft LENGTH ft ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAR T WELL ft FOUNDATION ft PROPERTY LINE ft <br />SEEPAGE PITS NUMBER WIDTH 771 ft DEPTH 2.-c. ft <br />DISTANCE TO NEAREST WELL I CV ft FOUNDATION i ot 4 ft PROPERTY LINE '. f 1 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 />STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br />i l <br />MIN M 48 HO 7 AD NCE NOTICE REQUIRED FOR INSPECT! NS - PLEASE CALL (209) 953-7697 <br />SIGNED,AQ <br />2 <br />14/1/1- <br />TITLE (3-.E:(--/ DATE c__..C,/ 7 -'4 ) fj ze <br />PAYMENT <br /> dxf RECEIVED <br />4,144,Y 1 7 2021 <br />SAN JOAQUIN COUNTY <br />1.4-aetr RTMENT <br />ENVIR ON MEN TA _ <br />HEALTH DEN, :SS3121(KIV 3.LIS Character of Soil to Depth of 3 Ft: <br />COMMENTS n J er ir <br />4rer.4" 575 ( 770 - Lotccel Aporri <br />Arivrri(9,i *r_v <br />it/Sump Soil Ch er: . (--(41t1 <br /> <br />Area Ili 41.6? Employee I D# D <br />SPECIAL PERMIT - Approved by <br />ar <br />Date <br />Date <br />fret- <br />DEPARTMENT USE ONLY <br />Application Accepted By <br />Final Inspection By <br />PE <br />Code <br />SC <br />INFO <br />Received <br />y <br />Check#/ <br />Cash <br />Amount <br />Remitted , <br />Date Permit/ <br />Service Request # Invoice # Permit ID# <br />-PIO pc <br />7(1,2______ <br />110138 300 -11- z <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4/14/18