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WATER TABLE DEPTH: / LI 0 "- ISO ft GEOGRAPHICAL INFORMATION: Coordinates X <br />REPAIR/ADDMON <br />PERC TEST It <br /> <br />BUILDING PERMIT* I CR) I c,01 LAND USE APPLICATION <br />TYPE OF WORK: NEW INSTALLATION <br />L REPLACEMENT 0 OUT-OF-SERVICE SEP DC SYSTEM <br />C ENGINEER DESIGNED/ALTERNATIVE <br />DESTRUCTION <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 I PCIQi CITY/ZIP <br />CROSS STREET 9(e. <br />OWNER NAME Pii41 <br />OWNER ADDRESS A.SCI yv f., <br />CONTRACTOR CA' 54 kit I 1/441/47 -CAC PHONE <br />CONTRACTOR ADDRESS 3 71411 1:44.0. kg401" Ak.Or. orasTATEizip <br />LICENSE ii)(742 0:3C-36 OTHER NUMBER 16-90 V.,CEXPIRATION DATE <br />PHONE <br />Sfecticw, IA- 7S-041 <br />CITY/STATE/ZIP <br />APN 06113 9 0 1 PARCEL SIZE q 3 <br />A <br /> <br />INSTALLATION WILL SERVE: RESIDENCE 0 COMMERCIAL ( 0 OTHER <br /> <br />NUMBER OF LIVING UNITS: 1 NUMBER OF BEDROOMS: 1) NUMBER OF EMPLOYEES: <br />/00/4ele /PT 6 CAPACITY <br /> CAPACITY gal # OF COMPARTMENTS <br />DISTANCE TO NEAREST: WELL /00 / ft FOUNDATION 4- / ft PROPERTY LINE 6-0 ft <br />LIFT STATION SIZE TYPE OF PUMP 11 PKG TX PLANT 0 SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br /> <br />X SEPTIC TANK TYPE/MFG <br />CI GREASE TRAP TYPE/MFG <br />14;60 <br />gal # OF COMPARTMENTS ,2 <br />Application Accepted Area 4.4 Employee ID# <br />PE <br />Code <br />SC Received_ f...i.......,d <br />. Remitted ate ob S ic Invoice # Permit ID# INFO ,By, iih-- — q - <br />43 li 0 G — O -2-Y ./ 457 11 d- s 6 <br />gi..i.st <br />X LEACH LINES 0 LEACHING CHAMBERS it OF LINES NGTH OF LINES ft <br />DISTANCE TO NEAREST WELL___________ dr ft FOUNDATION /ft PROPERTY LINE 0) ft <br />FILTER BED WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />U MOUNDED WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />U 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 0 NEAR WELL ft FOUNDATION ft PROPERTY LINE ft <br />y SEEPAGE PITS NUMBER WIDTH 'I" (W") ft DEPTH (PSI ft <br />DISTANCE TO NEAREST WELL /.5Q' ft FOUNDATION /00 / 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 />MINIMUM 48 HOUR A ANCE N TICE REQUIRED FOR INSPECTIONS - PL ASE CALL (209) 953-7697 <br />SIGNED TITLE et/ DATE 2 - <br /> _ <br /> ii <br />p9 <br />'c400 <br /> 2 3 2n <br />A l(31:10 <br />7.1 <br />21 <br /> <br />4 4/ ifCot/ <br />4f iV7,-4111Y <br />diRr4fEN7, <br />DEPARTMEN U E ONLY <br /> Date, 4.2 <br />Final Inspection By <br />Character of Soil to of 3 Ft: <br />Date 2 -149z.1 )(SPECIAL PERMIT -Approved by <br />Pi Sump Soil Ch racter: <br />COMMENTS 'Jew.) s Sr------AT$7:Nie) fit% h <br />re CO rd-C • No-te:-114-Ot y 4,44 0142- - p&rni-t ViS/2-1 2-14 'LL <br />_ Oa . • I MLA <br />ele4-. Amount Permit/ <br />'`e fo <br />i xlm&-"ed y f-s3 ;61 c1.049- -115 ONSITE WASTEWATER TRT YSTEM PERMIT <br />0•P -tern‘i oIn(Lep/ ts-itr-: de6+411