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CONTRACTOR ADDRESS A4o1 c.,) • o s-r. CITY/STATE/Zip Let) t ctra4o <br />LAND USE APPLICATION # BUILDING PERMIT # <br />TYPE OF WORK: REPAIR/ADDITION <br />OUT-OF-SERVICE SEPTIC SYSTEM O <br />0 ENGINEER DESIGNED/ALTERNATIVE <br />DESTRUCTION <br />NEW INSTALLATION <br />REPLACEMENT <br />0 RESIDENCE 0 COMMERCIAL INSTALLATION WILL SERVE: 0 OTHER <br />NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: NUMBER OF LIVING UNITS: <br /> gal # OF COMPARTMENTS <br /> gal # oF COMPARTMENTS <br />ft PROPERTY LINE ft <br />SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />CAPACITY <br />CAPACITY <br />FOUNDATION <br />PKG TX PLANT <br />FOUNDATION ft PROPERTY LINE <br />FOUNDATION ft PROPERTY LINE <br />FOUNDATION ft PROPERTY LINE <br />WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X <br />3iC PERC TEST # /41 <br />0 <br />0 <br />0 <br />SEPTIC TANK <br />GREASE TRAP <br />LIFT STATION <br />TYPE/MFG <br />TYPE/MFG <br />DISTANCE TO NEAREST: <br />SIZE TYPE <br />WELL ft <br />OF PUMP <br />0 LEACH LINES LEACHING CHAMBERS <br />DISTANCE TO NEAREST WELL ft <br />0 FILTER BED WIDTH ft LENGTH <br />DISTANCE TO NEAREST WELL ft <br />MOUNDED WIDTH ft LENGTH <br />DISTANCE TO NEAREST WELL ft <br />0 SUMPS WIDTH ft LENGTH <br />DISTANCE TO NEAREST WELL ft <br />0 DISPOSAL POND S WIDTH ft LENGTH <br />DISTANCE TO NEAREST WELL ft <br />0 SEEPAGE PITS NUMBER WIDTH <br />DISTANCE TO NEAREST WELL ft <br /># OF LINES LENGTH OF LINES ft <br />FOUNDATION ft PROPERTY LINE ft <br />ft DEPTH ft <br />ft DEPTH <br />ft DEPTH <br />ft DEPTH <br />FOUNDATION ft PROPERTY LINE <br />ft DEPTH <br />FOUNDATION ft PROPERTY LINE ft <br />ft <br />ft <br />ft <br />ft <br />ft <br />ft <br />ft <br />ft <br />I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPUCATION 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 UR ALICE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209)953-7697 <br />SIGNED TITLE ?AU • vfr1 &-12- • DATE 2..- 2. <br />JOB ADDRESS 33iI0 <br />CROSS STREET <br />OWNER NAME Sc 0/ <br />OWNER ADDRESS P.c.SD'A 440 <br />. irwsivri 2.31 I 0 Cifyizip Arc, ormP <br />e.J . V ST"..) <br /> APN - - i3 • - PARCEL SIZE I (0 0 Arc • err or--6 <br />cAThlut-c, PHONE 4cf log 0 i <br />L.E. er.-rr <br />CrryISTATEizip Ac Pr-m. pc, CA <br />CONTRACTOR LIU 0 154 &EDE-NV I/2- 014-) Ar-rft PHONE 3 L09 - o3-1 r <br />LICENSE 00C-42 00C-36 OTHER C & NUMBER 2-IS-I EXPIRATION DATE 4- 30 - 2- :SSMICIOV H.LIS ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH <br />NON-REFUNDABLE PERMIT <br />DEPARTMENT 1 868 E. HAZELTON AVENUE - STocK-roN CA 95205 - (209)468-3420 <br />CALL (209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />I <br />7 <br />1 6 <br />'----11. <br />, 1 <br />i <br />iR .!"— <br />17 1g <br />Cn <br />iii <br />& P., ^ rg <br />- <br />_II _ <br />., /A-'' • <br />C!.,5 ) <br />0 / ' 19,1 I I <br />z...L_DEPARTMENT US4E ONLY <br />Application Accepted By Date c9/FpI Area /a q <br />Final Inspection By Date 0 SPECIAL PERMIT -Approved by <br />Employee <br />Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br />COMMENTS <br />PE <br />Code <br />SC <br />INFO <br />Received <br />B <br />Chec <br />ash <br />Amount <br />Remitted Date Permit/ <br />Service Request # Invoice # Permit ID# <br />4.2.) SO3 1 i Ce9 , ,..!--' fl 5,2 2-8-21 S e DO?)32- I <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4/14/18