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CITY/ZIP +4:10/#%,e.) tdk" 15'22- <br />p N 75CIA, km PARCEL E +If <br />PHONE C/14.'"- ee?:-/.25-8 <br />CITY/STATE/ZIP ,keled9,400.--95-"AP45 <br />PHONE _APIA SW. 7 <br />Ls CITY/STATE/ZIP zogt. 91-P162-- <br /> NUMBER gs-fovs- EXPIRATION DATE -- 21-19" <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205- (209)468-3420 <br />I "Id -REFUNDABLE PERMIT CALL (209) 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />CONTRACTOR id PA <br />CONTRACTOR ADDRESS 314 41 <br />LICENSE )tif-42 ULiC-36 OTHER <br />JOB AthRESS 1,25a23 veto 7204i <br />CRGSS STREET zoe;s- AA/ <br />OWNER NAME *"Sirki.„1,e,g,. A60 gt*c./.314- <br />OWNER ADDRESS <br />I 31) <br />Application Accept. <br />Final Inspection By <br />Character of Soil to <br />COMMENTS <br />fliCT31(47 <br />pth of 3 Ft <br />5 <br />/PEPARTMENJ/JSEpPgJ.Y <br />Date _ <br />Date <br />Area 4/.41 Employee Olt MUG" <br />. SPECIAL PERMIT - Approved by <br />1/Sump Soil Character: <br />/A a <br />t V <br />ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />WATER TABLE DEPTH: (WI It GEOGRAPHICAL INFORMATION: Coordinates X <br />PERC TEST # [pUILDING PERMIT # AP) TraqCitt LAND USE APPLICATION # <br />TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION <br />REPLACEMENT . OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br />ENGINEER DESIGNED /ALTERNATIVE <br />OTHER <br />NUMBER OF EMPLOYEES: <br />gal It OF COMPARTMENTS til" X SEPTIC TANK TYPE/MFG (ao f CAPACITY .49ati <br />0 GREASE TRAP <br />LIFT STATION <br /> <br />INSTALLATION WILL SERVE: RESIDENCE I COMMERCIAL „t <br /> <br />NUMBER OF LIVING UNITS: I NUMBER OF BEDROOMS: <br />TYPE/MFG CAPACITY gal if OF COMPARTMENTS <br />DISTANCE TO NEARES1: WELL tQ ft FOUNI1ATION_3 ft PROPERTY LINE g6 ft <br />SIZE TYPE OF PUMP PKG TX PLANT 0 SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />LEACH LINES LEACHING CHAMBERS if OF LINES tg LENGTH OF LINES .6.5". <br />DISTANCE TO NEAREST WELL • ft FOUNDATION.. If /3" PROPERTY LINE ft <br /> <br />DEPTH ft <br /> II PROPERTY LINE ft <br /> ft DEPTH It <br />ft <br /> <br />ft ft <br />ft <br />FILTER BED <br />ID MOUNDED <br />CI SUMPS <br />WIDTH ft LENGTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION <br />WIDTH It LENGTH <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY UNE <br />WIDTH it LENGTH DEPTH <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE <br />DISPOSAL PONDS WIDTH ft LENGTH _ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION 1 It PROPERTY LINE <br />SEEPAGE PITS NUMBER 2 WIDTH *J • , ft DEPTH OS"' <br />DISTANCE TO NEAREST WELL 15Q_i.. ft FOUNDATION /5— ft PROPERTY LINE <br /> <br />ft <br /> <br />I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPUCATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN <br />JOAOUIN 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 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209)953-7697 <br />SIGNED <br /> TITLE 0,,L-41k..41ge: DATE 14 52-2 <br /> r 404- itatki051.5 14.1 <br />PE <br />Code <br />SC <br />INFO B <br />Received ri"--tec.kftp Amount <br />emi ed Date Permit/ <br />Service Request # Invoice # RECEIVE <br />4 iMy 0 ! 1 /2-1-11 (-1)iDci-AC) —APR-21-201 3 <br />?.? <br />SAN JOAQUIN COUNTY <br />ONSITE WASTEWATER TFurnencitROMMENI1Mr <br />HEALTH DEPARTMENT <br />42-01 <br />5/5/17