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TITLE 47 /0 1- DATE SIGNED <br />610 W4-) <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 6 00//e4te FizEnizi-1OfreP12-44D ciTyizip f2rAtt.17( <br />CROSS STREET E l.Dop,4-po APN - oc0--// /f3 -ew- a, PARCEL SIZE `2g • 3/ <br />OWNER NAME PA PE" PRoPE2z77e_5 / / A/Ce PHONE 7-75-.17- /654 <br />OWNER ADDRESS 353- 400P/115-ntizE 04.4 ,410 12-0 • 4300 <br />CONTRACTOR ellE-54E1 601LISG11.17A/0 <br />p.o .130K -37q4 <br />LICENSE EL C-42 Li C-36 OTHER ge <br />CITY/STATE/ZIP 4-te4avif R 77400 <br />PHONE 0701 - 4-02 ^/G5a? <br />CITY/STATE/ZIP 7 /Z4-004 cA s-,E3 CONTRACTOR ADDRESS <br />NUMBER 7547, EXPIRATION DATE 6 Ao/.2_3 <br />WATER TABLE DEPTH: ó2- ft GEOGRAPHICAL INFORMATION: Coordinates X <br />PERC TEST # .2 BUILDING PERMIT # LAND USE APPLICATION # <br /> <br />TYPE OF WORK: NEW INSTALLATION <br />REPLACEMENT <br />REPAIR/ADDITION <br />OUT-OF-SERVICE SEPTIC SYSTEM <br />INSTALLATION WILL SERVE: 0 RESIDENCE <br />NUMBER OF LIVING UNITS: <br />Li COMMERCIAL <br />NUMBER OF BEDROOMS: <br />0 <br />0 <br />SEPTIC TANK <br />GREASE TRAP <br />LIFT STATION <br />TYPE/MFG CAPACITY <br />TYPE/MFG CAPACITY <br />DISTANCE TO NEAREST: <br />SIZE TYPE <br />WELL ft FOUNDATION <br />OF PUMP PKG TX PLANT 0 <br />0 LEACH LINES LEACHING CHAMBERS <br />DISTANCE TO NEAREST <br /># OF LINES <br />WELL ft FOUNDATION <br />CI FILTER BED WIDTH ft LENGTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION <br />0 MOUNDED WIDTH ft LENGTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION <br />CI SUMPS WIDTH ft LENGTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION <br />0 DISPOSAL PONDS WIDTH ft LENGTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION <br />0 SEEPAGE PITS NUMBER WIDTH <br />DISTANCE TO NEAREST WELL ft FOUNDATION <br />ENGINEER DESIGNED /ALTERNATIVE <br />DESTRUCTION <br />0 OTHER <br />NUMBER OF EMPLOYEES: <br />gal # OF COMPARTMENTS <br />gal # OF COMPARTMENTS <br />ft PROPERTY LINE ft <br />SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />LENGTH OF LINES ft <br />ft PROPERTY LINE ft <br />DEPTH <br />PA YAA <br />ft <br />ft PROPERTY LINEr.. ....Eiv ft <br />DEPTH Neoe r / treb <br />ft <br />ft PROPERTY LIT,. 1 _ 4 ft <br />DEPTH <br />Siliv.„, I 2022 <br /> ft <br />ft PROPER Eic,„tieuriv c ft <br />DEPTH N8.10.1440ENpitieiv(7),.rry ft <br />ft PROPERTY LINE ARTA/on. ft <br />ft DEPTH ft <br />ft PROPERTY LINE 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 AN CTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br />WORKERS C NSATION L . <br />M 48 H DVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209)953-7697 <br />L e DEPARTMENT ;JSE/ONLY <br />Application Accepted B Date /072-W22_ <br />am moi 1 r ar <br />Final Inspection By Date 1 1 1, 9 ( 7:T._..- Li PERMIT - Approved by <br />Character of Soil to Depth of 3 Ft: it/Sump Soil Character: <br />COMMENTS .2- he-4-5 — 2 - dy--e--Ite slay c . <br />PE <br />Code <br />SC <br />INFO <br />Received <br />By <br />Chec Amount <br />Remitted Date Permit/ <br />Service Re uest # Invoice # Permit ID# bash <br />V2 2-2 523 d45)_ 3(732_ isiz. Div/121 E0(A 3 1 <br />Area CO 9 Employee ID# :ssaaacw ails ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 42-01 <br />5/5/17