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QC-36 OTHER -4 LICENSE <br />PHONE <br />Lcj C&_CED <br />CITY/ZIP JOB ADDRESS <br />APN <br />CITY/STATE/ZIP <br />NON-REFuNDAe PE CA p 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />t. <br />CROSS STREET <br />OWNER NAME <br />OWNER ADDRESS <br />CONTRACTOR 0 AA • <br />CONTRACTOR ADDRESS 4 CITY/STATE/ZIP <br />NUMBEIL IDCE t 1 EXPIRATION DATE tilL <br />12-07ztrD <br />(-A-(2-a— Par; <br />p2,9 -14-1,12-0A <br />it\-(242A.5 Set-75 ikLpHoNE <br />1\1 Wit-Ci <br />IARCEL SIZE • <br />1-3( 0 <br />WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X <br />D PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # <br />TYPE OF WORK: U NEW INSTALLATI REPAIR/ADDITION <br />0 REPLACEMENT %f1'_tL-0 OUT-OF-SERVICE SEPTIC SYSTEM <br />0 OTHER <br />NUMBER OF EMPLOYEES: <br />I <br /> <br />Ci( SEPTIC TANK TYPE/MFG V, ' , IL— CAPACITY \ 20 C gal # OF COMPARTMENTS 2_, <br />GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS <br />DISTANCE TO NEAREST: WELL V% Jr- ft FOUNDATION 0 ft PROPERTY LINE \ trrt- ft <br />ID LIFT STATION SIZE TYPE OF PUMP CI PKG TX PLANT CI SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />11, LEACH LINES * LEACHING CHAMBERS c q) 2 4- # OF LINES i LENGTH OF LINES 40 ft <br />DISTANCE TO NEARESTWELL 1 00 l- ft FOUNDATION '3 0 -r ft PROPERTY LINE '..-.1-1± ft <br />FILTER BED WIDTH ft LENGTH ftDEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />MOUNDED WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />SUMPS WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />ID DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NE .. WELL ft FOUNDATION ft PROPERTY UNE ft 44:,44' <br />X SEEPAGE PITS NUMBER e II '-'75 It DEPTH ft n "J <br />DISTANCE TO NEAREST WELL /LIS OT ft FOUNDATION r .7-i O—t— ft PROPERTY LINE 1 , / ft <br />I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE 114 ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br />STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> <br />LITIC)Lly letrEOMQUIRED FOR <br />DATE <br /> <br /> T1TL <br />E CALL (209).953-71.-U- <br /> <br />INSTALLATION WILL SERVE: I (/4. RESIDENCE 0 COMMERCIAL <br /> <br />NUMBER OF LIVING UNITS: . NUMBER OF BEDROOMS: <br />3 <br />SIGNED <br />ENGINEER DESIGNED /ALTERNATIVE <br />DESTRUCTION <br />F. , <br />htto;16 <br />ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 E MAIN STREET - STOCKTON CA 95202 - (209)468-3420 <br />EPARTNIEN SE,ONLY <br />Application Accep -- ted; t --Li _Alt./ ... Date 2-- Area Employee ID# i:_:_iyy <br />Final Inspection By Date 017. 403 r. WAVERErr Date 0 SPECIAL PERMIT - ApproveproillFNI. <br />Character of Soil to D pth of 3 Ft: Pit/Sump Soil Character: RccENFD <br />COMMENTS (;LI-i) -07- (-.7-- /1---izf17 : ,,,_ 4, A 1.4c! r‘;ii .AX---:4-elA-7-c7—n(::-') c--S/7'--- /)2-e-'9Vii125 <br /> t),41/÷4--- ic-E-7.1 , , JUN Z L <br />,to,tatEc,inist.ri <br />PE <br />Code <br />SC <br />INFO By <br />Received ChecIOL - <br />Cash <br />Amount <br />Remitted Date Permit/ <br />Service Request # Invoice # <br />HrA,I ' <br />Permit ID# <br />Z-I-2 t'l I i > U I3--I ct_.,Z V ' &Pi 1 1 2 -,4. : 7-0 0 --;•zz-7 L.; <br />42-01 <br /> ONSITE WASTEWATER TRTTANT SYSTEM PERMIT <br />9/21/10