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OWNER ADDRESS P- 0 B S-c9 Fif enGh (6 hip g S-G2 3 ) CITY/STATE/ZIP <br />Po 466 x tp CONTRACTOR ADDRESS <br />ft GEOGRAPHICAL INFORMATION: Coordinates X <br />TYPE OF WORK: <br />DESTRUCTION <br />Ll ENGINEER DESIGNED /ALTERNATIVE <br />ta t11( <br />P1 NEW INSTALLATION REPAIR/ADDITION • <br />REPLACEMENT Tat 1/1k ci Id LI OUT-OF-SERVICE SEPTIC SYSTEM <br />INSTALLATION WILL SERVE: <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br />ESIDENCE LI COMMERCIAL 11 OTHER <br /> CAPACITY <br /> CAPACITY <br />ft FOUNDATION 5' <br />Li LEACHING CHAMBERS # OF LINES LENGTH OF LINES 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 :SSINOUV 3.IIS DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />WIDTH 01 ft LENGTH . 3L. I . ft DEPTH / S 11 ft <br />DISTANCE TO NEAREST WELL I. (SO I ft FOUNDATION i 0 I ft PROPERTY LINE Of _ c ft <br />WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />S WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />NUMBER WIDTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />0'..."-SEPTIC TANK <br />GREASE TRAP <br />LEACH LINES <br />la41-11TER BED <br />MOUNDED <br />SUMPS <br />DISPOSAL POND <br />SEEPAGE PITS <br />LIFT STATION <br />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 H UR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209)953-76 7 <br />SIGNED TITLE Ca-)71 C DATE 3 <br />ii <br />7/9 <br />,C7 <br />rig Employee ID# A( <br />DEPARTMENT IlqE ONLY <br />Application Accepted By 'e-7-2------ —/- Z-- Date 3A,pi Area <br />Final Inspection By5kz,./\ VI M.,. ACII, Date ,5 1 V\ <br />Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br />COMMENTS rck 1 i i rj sksliem Al t \le i IS y,1 . k Lin .51.4100.16,kS per E riD (et° ras <br />/\14 4e II or parte 1. V fc-A1.-Vcci.se --9,--). <br />PE <br />Code <br />SC <br />INFO <br />Received <br />By <br />(ChecIte <br />Cash <br />Amount <br />Remitted Date Permit/ <br />Service Request # Invoice # Permit ID# <br />L) /)j VT UJ7Zr iv-7-7-7. poo --1-'71cs-,z3.3z-sLige;) <br />ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />0 SPECIAL PERMIT - Approved by <br />,124ymp,, <br />IW-Certrivia <br />,..,..10,4ini, „.. <br />cigni Ck-NOu <br />I Nry Drp Nal/.._ /1,c• r ..4zAr <br />14AR 31 <br />2azi SAN <br />42-01 <br />4/14/18 <br />CONTRACTOR <br />BUILDING PERMIT # LAND USE APPLICATION # <br />WATER TABLE DEPTH: hi - <br />E PERC TEST # <br />TYPE/MFG <br />TYPE/MFG <br />DISTANCE TO NEAREST: WELL <br />SIZE TYPE OF PUMP CI PKG TX PLANT 0 SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />10 ,-) <br />gal # OF COMPARTMENTS <br />ft PROPERTY LINE ir ft <br />gal # OF COMPARTMENTS A <br />JOB ADDRESS 36)(-.L., CITY/ZIP <br />CROSS STREET et3ite-34.- MC 1<in iey APN PARCEL SIZE <br />OWNER NAME GIO (V6if ( PHONE <br />PHONE <br />CITY/STATE/ZIP 1le4is-ge#4- Cri <br />NUMBER 6.70 [5'155'14 EXPIRATION DATE LICENSE E Fr C-42 El C-36 OTHER