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JOB ADDRESS (../ 0 3 L.0_ 7>L-z=n4 A-)E CrTY/Zip -1-12,ArC s--3 0 4, <br />CROSS STREET ,Ni> I S APN Z13- /co- z S. PARCEL SIZE ‘", (0 • C- A-c • <br /> <br />OWNER NAME te--7 J\-) <br /> <br />PHONE <br /> <br />OWNER ADDRESS 5A Ale: CITY/STATE/ZIP <br /> <br />CONTRACTOR Li Li V E orA GEO EA./VI 12-0 N.) roc x/TA L PHONE 319 031 F <br />CONTRACTOR ADDRESS 4+01 ti) • 0 Ps V- ST • CrraSTATE/ZiP LOBO c--A 9 Ss* 2.y 0 <br />LICENSE El C-42 00C-36 OTHER Cec. NUMBER 2-IC EXPIRATION DATE 44 - 30 -2.-a. <br /> <br />ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STocicroN CA 95205 -(209) 468-3420 <br />NON-REFUNDABLE PERMIT CALL (209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X <br />PERC TEST # 2, BUILDING PERMIT # <br /> <br />LAND USE APPUCATION # <br />TYPE OF WORK: 0 NEW INSTALLATION <br />0 REPLACEMENT <br />REPAIR/ADDMON <br />OUT-OF-SERVICE SEPTIC SYSTEM <br />ENGINEER DESIGNED /ALTERNATIVE <br />0 DESTRUCTION <br />INSTALLATION WILL SERVE: 0 RESIDENCE <br />NUMBER OF LIVING UNITS: <br />E COMMERCIAL <br />NUMBER OF BEDROOMS: <br />OTHER <br />NUMBER OF EMPLOYEES: <br />0 <br />0 <br />0 <br />SEPTIC TANK TYPE/MFG CAPACITY gal # OF COMPARTMENTS <br />GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS <br />DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br />LIFT STATION SIZE TYPE OF PUMP 0 PKG TX PLANT 0 SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />0 LEACH LINES LI LEACHING CHAMBERS # OF LINES LENGTH OF LINES ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />0 FILTER BED WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />0 MOUNDED WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />0 SUMPS WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />0 DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />0 SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />I HEREBY CER-I1FY 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 4841OUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209)953-7697 <br />SIGNED <br />TITLE ete-0 3 . 44 6-12- • DATE Sr (11- 2- 1 <br />1111=MMIIIIMMI <br />MENNE= <br />M1111111111111111111111MIN <br />1111111111111M11111111 <br />MINIIIIMI11111111= <br />INEINIIMMENNE <br />MIIMI=1111111111=1 <br />IMINNE111111111111= <br />111111111110=11111111111111 <br />11111111111=111111111= <br />DEPARTMENTIJSE ONLY <br />Application Accepted By Date <br />Final Inspection By Date <br />NINIIIME=11111111111M <br />It11111111MENEMEIN <br />111111111=111=1•1111 <br />IMEMIE1111111111=1111 <br />MillEr1111111==1111 <br />11111111111=MTI <br />INIIIIM1111111111higi.niftWr <br />.111111111....11111111 <br />4 2021 <br />MEMENNIIIARilaN c <br />.111.110111MUNOWE P .1‘17°INT),311. <br />IJAqEJ <br />Vet ea Ar S Employee IC# <br /> 0 SPEdIAL PERMIT - Approved by <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 />By <br />(Cheolede <br />Cash <br />Amount <br />Remitted Date <br />I 1 <br />Permit/ <br />Service Request # Invoice # Permit ID# <br />Li ;d p eKihi c 3 1 —i -62(.0 4.30?-1 51111 21 \c2-OUS--'J,-c1-0 <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4/14/18