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qz./ 12-73 7 7 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X <br />BUILDING PERMIT #1=1)._110.0 6,5 LAND USE APPLICATION # <br />NEW INSTALLATION R PAIR/ADDMON ENGINEER DESIGNED /ALTERNATIVE <br />REPLACEMENT ” OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br />RESIDENCE COMMERCIAL <br />NUMBER OF BEDROOMS: <br />TYPE/MFG ? CAPACITY <br />TYPE/MFG CAPACITY <br />DISTANCE TO NEAREST: WELL 4.04.) <br />A1 <br /> -F <br />J., <br />ft FOUNDATION <br />LIFT STATION SIZE TYPE OF PUMP PKG TX PLANT <br />INSTALLATION WILL SERVE: <br />NUMBER OF LIVING UNITS: <br />ft <br />131- SEPTIC TANK <br />GREASE TRAP <br /># OF COMPARTMENTS <br />I # OF COMPARTMENTS <br />ft PROPERTY LINE <br />SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />\if( LEACH LINES : LEACHING CHAMBERS # OF LINES LENGTH OF LINES 45 '. ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION i 1:1 ÷ ft PROPERTY LINE 17'- ft <br />FILTER BED WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />CI 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 />DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATI N ft PROPERTY LINE t ft <br />N•I SEEPAGE PITS NUMBER 1917 WIDTH DEPTH 'Z'S ft <br />DISTANCE TO NEAREST WELL 46b <br />1 <br />4" ft FOUNDATION 1 in --t- ft PROPERTY LINE 'cl 14... ft <br />I HEREBY CERTIFY 1NAT 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 ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE ::ALL 12091953-7697 <br />SIGNED 11"-- TITLE .5(0-1,0VAI3ATE '14 ^ <br />I I OTHER <br />NUMBER OF EMPLOYEES: <br />PE <br />Code <br />SC <br />INFO <br />Received Check*/ <br />cash <br />Amount <br />._Remitted Date " Permit/ Invoice!! -1 Permit ID# <br />4-)1 I I 11 <br />22_ <br />/ 14,54L- t cktf' ? Pi /PAI <br />Sern6ce fguest # <br />-,..0 <br />i <br />PERC TEST # <br />TYPE OF WORK: VS321CIOW 3.11S. 42-01 <br />4/14/18 <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCK TON CA 95205 - (209)468-3420 <br />NON-REFUNDABLE PERMIT„, CALL (209) 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />JOB ADDRESS 1,,1 1 .. H N t>.e...,-...,,---1 ciTymp ciV......e o C--c 7 "11.7\-0 <br />CROSS STREET F--- (--0 L1.- -h-. hdAPN4227.7 1-1 PARCEttZ <br />OWNER NAME V-5---e-- I -11 <br />OWNER ADDRESS '275' I 3 (4, N pe...),--1 <br />PHONE C' <br />CITY/STATE/ZiP ,4-c94,45 9r) 7\ <br />CONTRACTOR e o PHONE 2...1 6 71 C*7 <br />CONTRACTOR ADDRESS CITY/STATE/ZIP <br />LICENSE n C-42 n C-36 OTHER NUMBER EXPIRAllON DATE <br /> PAya- 0701,7 . <br />0 <br />4 2 <br />/Qv *ft <br />/kilt •vb <br />h DeNREeirv <br />444 <br />Application Accepted By . /Als...404 <br />P R <br />D <br />TI14 <br />ate ArgelAnif. Area c4/11 Employee ID# <br />, T <br />Final Inspection By Is k AL% Date 113M, '\ 17 SPECIAL PERMIT - Approved by <br />Character of Soil to Depth of 3 Ft: Pit/Stunia Soil Character: <br />COMMENTS/Tat-1S VAiDertriWei) . 4/r) 023:56:rkr=49 <br />rfice;AP aloe/1y <br />no,&0 ___ 14 a P t) • vivN