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> A <br />(0) <br />144-: 0'D C. <br />A. 43( r-x <br />Character of Soil to D1 h of F <br />COMMENTS <br />Pt ump So Character: <br />ink MAO,icL CAA/ Be:Me/a/VW <br />42-01 <br />S/5/17 <br />ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />EPARTMENT U E ONLY <br />Application Accepted By Date Area Employee !Dv Mtit_ <br />Final inspection By 411111LP 1"" Date Ti SPECIAL PERMIT - Approved by <br />PE <br />Code <br />SC <br />INFO <br />Received_._I <br />B <br />js#tec t''' <br />ash <br />Amount <br />le itted Date PermW <br />Service Request # Invoice N Permit ID# <br />7'f t 1 c oZ q 9-0 <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 EXPIRES 1 YEAR FROM DATE ISSUED <br />JOB ADDRESS sti'1 61 tA ,III:A LAAJC cftyrzft. sr° (J.:1.4J <br />CROSS STREET ONA. vs% APN og 5110 1 :5 PARCEL SIZE ' <br />OWNER NAME C.91-i NieS s-rot C Grt:6-) %,) PHONE <br />OWNER ADORE* S Pe\ t. 'CO; fc )2, C.: CITY/STATE/Zip 67004 ""/". nj <br />ConTnAcTon V1551 (....01\ 51 15A A( ,J,-.1( <br />CONTRACTOR ADDRESS .3) pn,-,-*.u..f £L. str <br />LICENSE ' C-42 I C-36 OTHER A NUMBER 6sits1 EXPIRATION DATE <br />PHONE 33c).--T3c)1 <br />cffyisTATE/zip L-OI -e-f :SSANCIOV aLIS eb <br />WATER TABLE DEPTH.7.71) ft GEOGRAPHICAL INFORMATION: Coordinates X <br />BUILDING PERMIT # <br /> <br />LAND USE APPLICATION # I PERC TEST # <br />TYPE OF WORK: NEW INSTALLATION <br />X REPLACEMENT <br />REPAIR/ADDITION <br />OUT-OF-SERVICE SEPTIC SYSTE <br />ENGINEER DESIGNED /ALTERNATIVE <br />DESTRUCTION <br /> <br />INSTALLATION WILL SERVE: 14 RESIDENCE <br /> <br />NUMBER OF LIVING UNITS: <br />LIFT STATION SIZE TYPE OF PUMP <br />I OTHER <br />NUMBER OF EMPLOYEES: <br />gal ri OF COMPARTMENTS <br />CAPACITY gal V OF COMPARTMENTS <br />It FOUNDATION S <br />ft PROPERTY LINE I ft <br />PKG TX PLANT SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />SEPTIC TANK TYPE/MFG <br /> L —%4 -Mk" <br />GREASE TRAP TYPE/MFG <br />DISTANCE TO NEAREST: WELL <br />I COMMERCIAL <br />NUMBER OF BEDROOMS* <br />/41? <br />CIPC <br />APA <br />, <br />CITY K-•-• <br /> <br />A OF LINES /2_, LENGTH OF LINES 52- ' ft <br />FOUNDATION I 0 ' ft PROPERTY LINE S . ft <br /> <br />ft DEPTH ft <br /> ft FOUNDATION ft PROPERTY LINE rt <br /> <br />ft DEPTH ft <br />It FOUNDATION ft PROPERTY LINE ft <br />ft LENGTH ft DEPTH ft <br />It FOUNDATION ft PROPERTY LINE ft <br />ft LENGTH ft DEPTH ft <br /> ft FOUNDATION ft PROPERTY LINE ft <br />Wenn .2% VI ft DEPTH IS ' ft <br />ft FOUNDATION "Z i ft PROPERTY LINE 5 ' ft <br />I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN <br />JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br />CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br />WORKERS COMPENSATION LAWS. <br />MINIMUM 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 <br />SIGNED TTLE'c((.iJ1 DATE <br />LEACH LINES $. LEACHING CHAMBERS I 1*- t (r.r <br />DISTANCE TO NEAREST WELL 50 ft <br />FILTER BED WIDTH ft LENGTH <br />DISTANCE TO NEAREST WELL <br />MOUNDED WIDTH ft LENGTH <br />DISTANCE TO NEAREST WELL <br />SUMPS WIDTH <br />DISTANCE TO NEAREST WELL <br />DISPOSAL PONDS Worn <br />DISTANCE TO NEAREST WELL <br />pc SEEPAGE PITS NUMBER 14 <br />DISTANCE TO NEAREST WELL I a•D <br />f\ei Won- vse.qi c\NN.NN <br />/oft <br />..1- <br />%./•- <br />4E4 <br />/40V <br />Afr. <br />‘240 <br />4cilzy <br />sity <br />c 014 <br />JOIkoopi <br />fte›AA