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010 <br />CrrvIZip TF <br />APN LiE1 10 9 <br />PHONE <br />PARCEL SIZE i Oa <br />qzs gq5 gçLis <br />ft GEOGRAPHICAL INFORMATION: Coordinates X <br />TYPE OF WORK: _ ENGINEER DESIGNED /ALTERNATIVE <br />_ DESTRUCTION <br />NEW INSTALLATIO,N _ REPAIR/ADDITION <br />X REPLACEMENT fr&ji g- t IC' _ OUT-OF-SERVICE SEPTIC SYSTEM <br />E OTHER E COMMERCIAL <br /> <br />INSTALLATION WILL SERVE: 0 RESIDENCE <br /> <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br />BUILDING PERMIT # LAND USE APPLICATION # <br />TYPE/MFG <br />TYPE/MFG <br />ft DISTANCE TO NEAREST: WELL <br />gal <br />gal <br />ft <br />0 SAND OIL SEPARATOR (ENCLOSED SYSTEM) SIZE TYPE OF PUMP <br />SEPTIC TANK <br />GREASE TRAP <br />LIFT STATION <br /># OF COMPARTMENTS <br /># OF COMPARTMENTS <br />PROPERTY LINE <br /> CAPACITY <br /> CAPACITY <br />ft FOUNDATION <br />PKG TX PLANT <br />WATER TABLE DEPTH: 1 1 0 <br />PERC TEST # :SSDIGOV 311S t . <br />tYr fl ,its (Jr? cit ,r)stV <br />P J <br />• <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 />6 <br />JOB ADDRESS <br />CROSS STREET JQ C I <br />i 4 <br />OWNER NAME 513 5041 P\Oft <br />OWNER ADDRESS .5 Apwk <br />CONTRACTOR .515?-€ /07 (urs.-1•QA)et.117 )1 <br />iCist13 pc, aid Lit° 112b <br />NUMBER r-)\ 1-S1 <br />CONTRACTOR ADDRESS <br />LICENSE L _C-42 _C-36 OTHER <br />CITY/STATE/ZIP <br />PHONE 2-0 f 17e/ pz <br />CITY/STATE/ZIP 7---K,Ae qi-roy <br />EXPIRATION DATE <br />LEACH LINES X LEACHING CHAMBERS <br />FILTER BED WIDTH L ft LENGTH 6(1 DISTANCE TO NEAREST WELL ISO ft FOUNDATION 10-4. <br />DISTANCE TO NEAREST WELL ft FOUNDATION <br />MOUNDED WIDTH ft LENGTH <br />DISTANCE TO NEAREST WELL ft FOUNDATION <br />SUMPS WIDTH ft LENGTH <br />DISTANCE TO NEAREST WELL <br /> ft FOUNDATION ft PROPERTY LINE ft <br />DISPOSAL PONDS WIDTH ft LENGTH <br /> ft DEPTH ft <br />DISTANCE TO NEAREST WELL <br />01 SEEPAGE PITS NUMBER LA WIDTH <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION ft PROPERTY LINE ft <br />ft DEPTH , ft <br />ft FOUNDATION FOti• ft PROPERTY LINE '40 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 />MINIfrJf8 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209)953-7697 <br />SIGNED TITLE rt,14,111111. DATE iL it -7 brLt• <br />C Ofr <br />Sky <br /> <br /># OF LINES "1- LENGTH OF LINES SI ft <br />ft PROPERTY LINE 4 0-3 ft <br /> <br />ft DEPTH 3",2 g <br />ft PROPERTY LINE <br /> <br />ft <br />ft DEPTH <br /> ft <br /> ft PROPERTY LINE <br /> <br />ft <br />ft DEPTH <br /> <br />ft <br />DEPARTMENT 4JSE1ONL Y <br />Employee ID# Application Accepted B - <br />Date ia ).g/i20,2/0 Area 46/4i .D <br />Date a gyzo-2-1 E SPECIAL PERMIT - Approved by <br /> Pit/Sump Soil Character: <br />Final Inspection By <br />Character of Soil to Depth of 3Ft: <br />CyMMENTS c.1i€ be b yiPs <br />bies h bc tiLandoof, <br />-f- 1V4 <br />013 • if <br />ks E reeeicis„ <br />o-C' ro, [vs <br />PE <br />Code <br />SC <br />INFO <br />Received <br />B <br />Check#/ <br />Cash <br />Amount <br />Remitted Date Permit/ <br />Service Request # Invoice # Permit ID# <br />9a 14 lis- <br />Elliv/ <br />Ce‘tot3 4300 /2/42.1 -00i6b0 5-1 <br />_ <br />room 10 -r septio- r <br />, Ive d omas if MIT <br />vveS lac (3-41 teecit-rieA yr).0,-±e4-icA tm-A r&f-npkecl