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0- PA-a CONTRACTOR ft WATER TABLE DEPTH: GEOGRAPHICAL INFORMATION: Coordinates X TYPE OF WORK: NEW INSTALLATION REPLACEMENT _ # OF COMPARTMENTS # OF COMPARTMENTS CAPACITY A 2400 gal CAPACITY gal ft FOUNDATION ft PROPERTY LINE ft ft ft ft ft ft ft FOUNDATION ft PROPERTY LINE ft DEPTH ft FOUNDATION ft PROPERTY LINE ft ft DEPTH ft ft PROPERTY LINE ft ft DEPTH ft it INSTALLATION WILL SERVE: RESIDENCE NUMBER OF LIVING UNITS: I I COMMERCIAL NUMBER OF BEDROOMS: H OTHER NUMBER OF EMPLOYEES: 3 Id SEPTIC TANK TYPE/MFG 121.• L. 0 GREASE TRAP TYPE/MEG DISTANCE TO NEAREST: WELL 0 LIFT STATION SIZE TYPE OF PUMP _ 0 LEACH LINES LEACHING CHAMBERS DISTANCE TO NEAREST WELL D FILTER BED WIDTH ft LENGTH DISTANCE TO NEAREST WELL _ ci MOUNDED WIDTH ft LENGTH DISTANCE TO NEAREST WELL 0 SUMPS WIDTH ft LENGTH DISTANCE TO NEAREST WELL 0 DISPOSAL PONDS WIDTH ft LENGTH DISTANCE TO NEAREST WELL 0 SEEPAGE PITS NUMBER WIDTH DISTANCE TO NEAREST WELL Li PERC TEST * LAND USE APPLICATION # I ENGINEER DESIGNED /ALTERNATIVE 6111, DESTRUCTION REPAIR/ADDITION OUT-OF-SERVICE SEPTIC SYSTEM L3 PKG TX PLANT CI SAND OIL SEPARATOR (ENCLOSED SYSTEM) ft It FOUNDATION ft PROPERTY LINE ft ft FOUNDATION BUILDING PERMIT /f ft If OF LINES ft FOUNDATION FOUNDATION LENGTH OF LINES It PROPERTY LINE ft DEPTH ft PROPERTY LINE DEPTH rforentrunu JOB ADDRESS CROSS STREET' k &ROW OWNER NAmailAalap LLQ 7_ OWNER ADDRESS 1.2.1, eArti CITY/ZIP . APN PARCEL SIZE PHOAO7 11 CITY/STATE/Zip ofactrr e4 9 WY...PHONE 46 -9&Y7 CITY/STATE/ZIP EXPIRATION DATE Is A I InflAirVIC 7 7 07 ce. EXPIR...., I Y,..A0 Rom nATF IUE 1..,91L.L. ICU JO' 1.11 II A 70 11-1:Ck. NumBER0551.1 MO -,S145 CONTRACTOR ADDRESS LICENSE Vi 1C-42 fir ,C-36 OTHER it4 40 5304 ct) CE REQUIRED FOR TITLE ASE CALL (205) r3-7p97 DATE I SIGNE DEPA RTMENT USE ONLY — 0-1^ Date tiik Area 1204 ei C i Employee 1110 5- n SPECIAL PERMIT - Approved ...Lamp of Charzetzr: — a-4e -fzrAq/14: JIliv 'AN Jo , . EAL-rt; %Airy 7.4 Application Accepted By Final inspection By L.naracter of Soil t COMMENTS 20/5 worgElmoomenlil=0" ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1968 E. HAZEll_TON AVENUE - STOCKTON CA 95205 -(209) 468-3420 I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. PE Code SC INFO Received By rChec....y) Amount Remitted Date Permit/ Service Request # Invoice it Pe-rrni. (WATT tash 4-24 0 I 1 )-- te) 4-6405-- 41.74--?- -7/4 /is-- z..)E_ 42,-01 ONSITE WASTEWATER THTMNT SYSTEM PERMIT ft 4/24/12