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EXPIRES 1 YEAR FROM DATE ISSUED NON-REFUNDABLE PERMIT CALL (209) 953-7697 FOR INSPECTIONS <br />GEOGRAPHICAL INFORMATION: Coordinates X ft WATER TABLE DEPTH: <br />LAND USE APPLICATION # BUILDING PERMIT # <br />TYPE OF WORK: L.I NEW INSTALLATION <br />I I REPLACEMENT <br />ri REPAIR/ADDITION I_ ENGINEER DESIGNED /A2._. RNA IVE <br />, OUT-OF-SERVICE SEPTIC SYSTEM NJ DESTRUCTION 3. <br />'OTHER <br />NUMBER OF EMPLOYEES: <br />0 RESIDENCE 0 COMMERCIAL <br />NUMBER OF BEDROOMS: <br />INSTALLATION WILL SERVE: <br />NUMBER OF LIVING UNITS: <br />gal # OF COMPARTMENTS <br />gal # OF COMPARTMENTS <br />ft PROPERTY LINE ft <br />CAPACITY <br />CAPACITY <br />ft FOUNDATION <br /> # OF LINES LENGTH OF LINES ft <br /> ft FOUNDATION ft PROPERTY LINE ft <br /> ft DEPTH ft CI FILTER BED WIDTH ft LENGTH <br />DISTANCE TO NEAREST WELL <br />CI MOUNDED WIDTH ft LENGTH <br />DISTANCE TO NEAREST WELL <br />DISTANCE TO NEAREST WELL <br />ft FOUNDATION ft PROPERTY LINE ft <br />ft DEPTH ft <br />la LEACH LINES = LEACHING CHAMBERS <br />ft FOUNDATION ft PROPERTY LINE ft <br />APPLICATION AND <br />E LAWS AND RULES A <br />I HEREBY CERTIFY THAT I HAVE PREPARED T HE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br />D REGULATIONS OF SAN JOAQUIN COUNTY, <br />SIGNED <br />.,._ INIMUM 48 HOUR VANCE NOTICE RE <br />42-01 <br />4/14118 <br />ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 -(209)468-3420 <br />JOB ADDRESS _12-1,,, s 1 _w 0_ ( ... _.g 0 0 cmdzip..-ferieVei.9 <br />CROSS STREET 4-111- Fikst? APN \C1\ \ - .) ' CA PARCEL -IZE 916 3 <br />OWNER NAME ------.,:\C‘r•r----rd, --e \.\-C----, PHONE <br />OWNER ADDRESS gqc-N.S.\<--- ---.C.) • CITY/STATE/ZIP \CNkrt-C--c--- CA °NS _ r. <br />CONTRACTOR i C5NAT \ S01-142m.--. ,---,-.6.4- -.--C... . PRONE DO`\ - S'Ac1 - \5l3 <br />CONTRACTOR ADDRESS Di-e_V-ZLe S • Cs-r-IC'-'6 .rti-t- CITY/STATE/Zip -----••••,., CA RS ?)(..._,,\.....0 <br />LICENSE 0 I 'C-42 0 C-36 OTHER NUMBER Lin (4`..t (0 EXPIRATION DATE <br />PERC TEST # :SS31IaaV 311S CI SEPTIC TANK TYPE/MFG <br />CI GREASE TRAP TYPE/MFG <br />DISTANCE TO NEAREST: WELL <br />LIFT STATION SIZE CI SAND OIL SEPARATOR (ENCLOSED SYSTEM) TYPE OF PUMP 0 PKG TX PLANT <br />UIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 <br /> TITLE \i\c-a- • c>sf--i,(5"--44C DATE t.st • A <br />PA 1- <br />Application Accepted By <br />Final Inspection By <br />Character of Soil to Depth of 3 Ft: <br />COMMENTS --ro <br />ckci\-vuov‘,0e-vcs,i <br />PE <br />Code <br />SC <br />INFO <br />Received <br />By <br />Check# Amount <br />emitted Date Date <br />Permit/ <br />Request # Invoice # Permit ID# <br />2— cfl-rb '40-2-612f-r8.56q7 <br />DEPARTME <br />Date <br />Date <br />EON Y <br />AYR& <br />'a SP-oo S Ilia . c111512-ic-P <br />Area Employee ID#A.41-5 <br />SPECIAL PERMIT - Approved by <br />Pit/Su p Soil Character: ee <br />6 A <br /><7022 <br />I/6 2 <br />ern/ iN tiekir,ireasmi, <br />DEPqr /AL rmt. e'r AT4k