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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 1416b SCCX:4) 11•4. <br />CROSS STREET Pc 4 ell Cc-4,1a <br />OWNER NAME Fu der <br />OWNER ADDRESS PO °A eS0 <br />CONTRACTOR 14/ v-c'S Zee-tett <br />CONTRACTOR ADDRESS AZ Al* 6, t-IS <br />LICENSE IJ C-42 0 L] C-36 OTHER <br />NUMBER _L2g4_a_:l-/ EXPIRATION DATE <br />WATER TABLE DEPTH: 90 - 5-0 ft GEOGRAPHICAL INFORMATION: Coordinates X <br />E PERC TEST # <br /> <br />BUILDING PERMIT # /go 3 g al I LAND USE APPLICATION # <br />TYPE OF WORK: INSTALLATION IJ REPAIR/ADDITION <br />LI ENGINEER DESIGNED /ALTERNATIVE <br />r REPLACEMENT 1_1 OUT-OF-SERVICE SEPTIC SYSTEM LI DESTRUCTION <br />INSTALLATION WILL SERVE: ci-RESIDENCE <br /> <br />0 COMMERCIAL <br />OTHER <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br />I;/SEPTIC TANK TYPE/MFG <br /> <br />CAPACITY / pc> gal # OF COMPARTMENTS a._ <br />10 GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS <br />DISTANCE TO NEAREST: WELL 1T2•1 ft FOUNDATION 3 ft PROPERTY LINE <br /> ft <br />LIFT STATION SIZE <br /> TYPE OF PUMP U PKG TX PLANT 0 SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />[a 1.'‹E---ACH LINES El LEACHING CHAMBERS # OF LINES 0.... LENGTH OF LINEs S& ft <br />DISTANCE TO NEAREST WELL ( est!. 7 ft FOUNDATION 101 ft PROPERTY LINE -? 0 1 ft <br />CI 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 />041.--JMPS WIDTH <br /> <br />.'ft LENGTH I Li I <br /> <br />ft DEPTH lial ft <br />DISTANCE TO NEAREST WELL I 573 1 ft FOUNDATION 01 ft PROPERTY LINE .754- ft <br />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 <br /> ft FOUNDATION <br /> ft PROPERTY LINE 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 />MINIMUM 48 HOUR A VANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 <br />SIGNED TITLE fl r <br />DATE I 13 J-1 <br />s <br />-e- (kel-eci <br />'Accent, 74 <br />2021 <br />‘o#1QUIN Coupe, HEA47-1RONI hike/ H pEA,4 ,TAL <br />Employee ID# <br />Final Inspection By P\ Date -2- V •1 E SPECIAL PERMIT - Approved by <br />Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br />COMMENTS Tit.; SF!?. Aiev4 SFR , flei j\it, „qe ilc f se tack.s per <br />(eco-rd , "Iwo Cb YYTCOA t Sftc IIV hc Iftre t_ 5 <br />CITY/ZIP /14-4.464 44 9s-376., <br />APN DS05-33G PARCEL SIZI )4c- <br />PHONE <br />Ow/STATE/ZIP ris-3.34 <br />PHONE <br />CITY/STATE/ZIP /44410-44L-mt Cet <br />SAN <br />DEPARTMENT USE ONLY <br />Application Accepted By Date //Vii Area Li q A ( :SS3110:1V 3,LIS PE <br />Code <br />SC <br />INFO <br />Received <br />By <br />(Checjigi Amount <br />Remitted Date Permit/ <br />Service Request # Invoice # Permit ID# -Cash <br />Id)) 117 <br />tm).7 -- <br />1h-0?), /-s-FLi t-r3-21 t.2.:(r),-)ic- <br />ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 42-01 <br />4/14/18