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SEPTIC TANK <br /> <br />TYPE/MFG <br />LI GREASE TRAP <br /> <br />TYPE/MFG <br />DISTANCE TO NEAREST: WELL <br />LIFT STATION SIZE TYPE OF PUMP <br />CAPACITY gal # OF COMPARTMENTS <br />CAPACITY gal # OF COMPARTMENTS <br />ft PROPERTY LINE <br /> ft <br />0 SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />ft FOUNDATION <br />PKG TX PLANT <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 <br /> <br />EXPIRES 1 YEAR FROM DATE ISSUED <br />le0 <br />CITY/ZIP CA <br /> <br />APN 0 e0DO PARCEL SIZE EC) + <br />PHONE <br /> <br />CITY/STATE/ZIP mcyi-teLL, ciS3 .36, <br /> <br />c-e C, PHONE <br />CITY/STATE/ZIP 104A-chlfr-.4 <br />JOB ADDRESS lo 3 <br />CROSS STREET to c c_sc <br />OWNER NAME <br /> e -042 'R. co-v_s <br />OWNER ADDRESS <br /> toI f-vcrcil Comp <br />CONTRACTOR <br /> <br />01 I fti—e,-1 -C "4C..(< <br />CONTRACTOR ADDRESS <br /> fror Ac6c ia <br />LICENSE 0 C-42 EC C-36 OTHER <br /> NUMBER6,0 &S-5-9 EXPIRATION DATE <br /> <br />D-0 aa, <br />WATER TABLE TABLE DEPTH: ° sjf‘ ft GEOGRAPHICAL INFORMATION: Coordinates X <br />PERC TEST # BUILDING PERMIT # <br /> <br />LAND USE APPLICATION # <br />REPAIRIADDITION <br />OUT-OF-SERVICE SEPTIC SYSTEM <br />DENCE <br /> <br />E COMMERCIAL <br />NUMBER OF BEDROOMS: ,12. <br />TYPE OF WORK: NEW INSTALLATION <br />REPLACEMENT <br />INSTALLATION WILL SERVE: <br />NUMBER OF LIVING UNITS: <br />ENGINEER DESIGNED /ALTERNATIVE <br />DESTRUCTION <br />E OTHER <br />NUMBER OF EMPLOYEES: <br />1:1" LEACH LINES LEACHING CHAMBERS # OF LINES <br /> LENGTH OF LINES ft <br />DISTANCE TO NEAREST WELL A ft <br />FOUNDATION i ft PROPERTY LINE •I ft <br />FILTER BED WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION <br /> <br />ft PROPERTY LINE ft <br />MOUNDED WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION <br /> ft PROPERTY LINE ft <br />SUMPS WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION <br /> <br />ft PROPERTY LINE ft <br />DISPOSAL PONDS WIDTH ft LENGTH <br />DISTANCE TO NEAREST WELL <br />SEEPAGE PITS <br /> <br />NUMBER WIDTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE 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 HOI4R ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209)953-7697 <br />SIGNED TITLE Cr-31.W c 04746— DATE C <br /> ft DEPTH ft <br />ft FOUNDATION <br /> <br />ft PROPERTY LINE ft <br />wri <br />4 <br />PARTMENT USE ONLY <br />COMMENTS Pc\ ) I I )1,.s Sy6'4eJ1,1, Pepo,i f Ci pp i'Z f f(iyy, coo reit )9 01 4 yr; A hne< 4 <br />13 ..sef2e(Ai-l)Y7 line!) , ..e-ixe4/ 5 11;A c ext.( i ar/P <br />Application Accepted By <br />--D <br />Final Inspection By .41 1— 4 4, <br />Character of Soil to Depth of 3 Ft. <br />Dae6/2./'ZI Area 3 Employee ID# <br />/ <br />Date C\ 1/D1_\ L SPECIAL PERMIT - Approved by <br />Pit/Sump Soil Character: <br />PE <br />Code <br />SC <br />INFO <br />Received <br />B <br />Chec <br />s <br />Amount <br />Remitted . p at Permit/ <br />Service Request # Invoice # Permit ID# <br />1-0.13 ii -- Igi2,Cc(--, tP1;11/1 L;7'grA7)qO5- <br />ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 42-01 <br />4/14/18