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DEPARTMENT USE ONLY <br /> Date 5-7 2.0 Area Employee ID# <br />Date l'A/ 14 isozz El SPECIAL PERMIT -Approved by <br /> Pit/Sump Soil Character: <br />••<-- <br />Application Accepted B <br />Final Inspection By <br />Character of Soil to Depth of 3 Ft: <br />/.,n54 b&e-chn_ept <br />R_. <br />(2-a <br />°WI 4e/C1 Wel I -1 <br />COMMENTS --TcAAA.kr— <br />I / ^ <br />Lt. 1.Ve 00 <br />/ <br />eceit , ED <br />ati <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 /44/ P/- i'A 4 -1,. 0 e CITY/ZIP 75AA )/ <br />CROSS STREET tfa.(A-Ac -9A,`-- APN I--?() 9 - i q 0- 3 3 PARCEL SIZE -7-----0 <br />OWNER NAME Ca fivoret 6if (4 +I t X A daSi LM C.— , PHONE 3 ‘ -- 1-7 V <br />CITY/STATE/ZIP <br />CONTRACTOR <br />CONTRACTOR ADDRESS /e' Ve9 <br />OWNER ADDRESS a.m/ w <br />11/4 7Le PHONE <br />CITY/STATE/ZIP /2e' •7 /./4 Csi A5'3/1" <br />Trete y )ex 951a 5/ <br />LICENSE P4-42 lilLIC-36 OTHER NUMBER f.77,76EXPIRATION DATE 5 3 0 <br />WATER TABLE DEPTH: <br /> ft <br />GEOGRAPHICAL INFORMATION: Coordinates X <br />E PERC TEST # <br /> <br />BUILDING PERMIT # LAND USE APPLICATION # <br />TYPE OF WORK: Y NEW INSTALLATION <br /> <br />REPAIR/ADDITION <br /> <br />ENGINEER DESIGNED /ALTERNATIVE <br />L1 REPLACEMENT <br />I I OUT-OF-SERVICE SEPTIC SYSTEM 0 DESTRUCTION <br /> <br />if"--R ESIDENCE <br /> <br />INSTALLATION WILL SERVE: <br />NUMBER OF LIVING UNITS: <br />0 COMMERCIAL <br />NUMBER OF BEDROOMS: <br />E OTHER <br /> <br />NUMBER OF EMPLOYEES: <br /> <br />trai/ SEPTIC TANK TYPE/MFG „2 oa <br />GREASE TRAP TYPE/MFG <br />DISTANCE TO NEAREST: WELL <br />CAPACITY 410' gal # OF COMPARTMENTS <br /> CAPACITY gal # OF COMPARTMENTS <br />ft FOUNDATION ft PROPERTY LINE <br /> ft <br />LIFT STATION SIZE TYPE OF PUMP D PKG TX PLANT U SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />LEACH LINES Li LEACHING CHAMBERS # OF LINES LENGTH OF LINES ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />FILTER BED WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />I:I MOUNDED WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />Li SUMPS WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE 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 ft FOUNDATION 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 • ! HO R Al. VA CE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 / . ooa-ww. <br />SIGNED -4011_ 3 IP' TITLE C)14,- C-- DATE "13" .2-2) <br />PE <br />Code <br />se <br />INFO <br />Received Amount <br />Remitted Date Permit/ <br />Service Request # Invoice # Permit ID# <br />l it e? <br />6i t <br />2511 4 s'1( - 20 wr•,-D-0 <br />42-01 <br /> <br />ONSITE WASTEWATER TRTMNT SYSTEM PER :SS32KRIV 3 4/14/18