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JOB ADDRE5 , F I 00 E . i Oili-ftn.sT/ 1 crryizip A-cervh Po IS-2-7-0 I. 13. v cr IN.) CROSS STR EET b0S-r" B%-) APN cut•1 - cDS170 - , - . . , -er itc4;a4..$) PARCEL SIZE i to 0 Pre • OWNER NAME Set< 0/ LEVEN-MIN) 1 i_S thiveittuuel-1-1 C /o cenmi Li...0 PHONE ‘ftf‘f -11P‘i 0 1 LEV E....rri NJ I OWNER ADDRESS P • en • 30**/- ,-+D COY/STATE/ZIP dacC en'nf'D CI V clr X 2- 0 CONTRACTOR LAVE &-coci.) v 0.• 0/.4n-1En/7-et PHONE 3 - o37 r CONTRACTOR ADDRESS 4-fo c.n.) 0 Ale- ST CITY/STATE/ZIP Lob t C." ci.S- 2.14 0 LICENSE 00C-42 f:C-36 OTHER C NUMBER 2-I I EXPIRATION DATE 1+. 30 Z.. INSTALLATION WILL SERVE: 0 RESIDENCE 0 COMMERCIAL 0 OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X PERC TEST TYPE OF WORK: 0 REPAIR/ADDITION REPLACEMENT 0 OUT-OF-SERVICE SEPTIC SYSTEM ENGINEER DESIGNED /ALTERNATIVE DESTRUCTION /1 NEW INSTALLATION 73UILDING PERMIT # LAND USE APPLICATION # CI SEPTIC TANK GREASE TRAP TYPE/MPG TYPE/MFG CAPACITY gal # OF COMPARTMENTS CAPACITY gal # OF COMPARTMENTS DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft UFT STATION SIZE TYPE OF PUMP PKG TX PLANT 0 SAND OIL SEPARATOR (ENCLOSED SYSTEM) LEACH LINES 0 LEACHING CHAMBERS # OF LINES LENGTH OF LINES ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft FILTER BED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft MOUNDED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft SUMPS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft DISPOSAL PONDS WIDTH ft LENGTH DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft SEEPAGE PITS NUMBER WIDTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY, SIGNED TITLE IPACU • i4-1 C.,"la • DATE 2- e- 2- MINIMUM UR ADry-tVCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209)953-7697 ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205- (209)468-3420 NON-REFUNDABLE PERMIT CALL (209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED I Ii I 1 ii — 4 N , li,Hhlillill if I Z1 g a ,, I E. g a r• - r--' i . ..,... 'F S i 0 . V; 1111111 q II — tq .. F A 1 \- E,.21 g a/ „r= 112: ? / DEPARTMENT USE ONLY Date t9,1 4a 1-1/1 g EmPiVe 4 4, : 1, Final Inspection BY - Application Accepted By .e,......---7/1-2 /....--L-.-- Date alepI Area Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: 0 SPECIAL PERMIT - Approv iii,,i1,044 / Z:),041k.)1934i, +1, PE Code SC INFO Received CaesicA6( B / Cash Amount Remitted Date Permit/ Service Request # Invoice # Permit ID# 11.2DL/ .Rt3 P C5IteCsi,e) .-45.3- 4.1-21 SIZDO12-52 :SSMICICW allS COMMENTS 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18