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NSITL <br /> SAN J15AQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 <br /> MON-REFUNDABLE PERMIT _ !C L.L. M? 953` 7697 FOR INSPECTIONS ExPIRES 'I YEAR FROM DATE ISSUED A` <br /> JOB ADDRESS el+ _-sCITY/ZIP <br /> CROSS STREET ex6olvoAPN �/ ( 72- /�� , PARCEL SIZE f <br /> --- <br /> OWNER NAME • — _ --- — _--PHONEQril G��jl� 2� r' <br /> ���, <br /> OWNER ADDRC SS —. ---CITY/STATE/ZIP <br /> CONTRACTOR �,�' � j / Y r- PHONE <br /> CONTRACTOR ADDRESS l��r�e — �{ CITY/STATE/ZIPl�ji�. I1�'1L �— <br /> LICENSE F-1I1C-42 I-.11 IC-36 OTHER NUMBER,9!�%fybg-E)CPIRATION DATE <br /> WATER TABLE DEPTH: 71-3 <br /> it GEOGRAPHICAL INFORMATION: Coordinates K Y <br /> D PERC TEST # l BUILDING PERMIT## LAND USE,'APPLICATION## _ 1 <br /> TYPE OF WORK: NEW INSTALLATION F_PAIR/ADDITION 1.1 ENGINEER DESIGNjVE <br /> REPLACEMENT 11 OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION ftr% AfIr <br /> INSTALLATION WILL SERVE: I tsESIDENCE n COMMERCIAL �j ❑ OTHERYED <br /> NUMBER OF LIVING UNITS:—_ — — _NUMBER OF BEDROOMS_ _ / NUMBER OF EMPLOYEA� <br /> GG SEPTIC TANTS TYPE/MFC �L'vn� CAPACITY _ gal it OF COTS <br /> F3 GREASE TRAP TYPE/MFT; ------- — CAPACITY gal #OF COnIw MJrft OUNTv <br /> EALTH pePENTAL <br /> DISTANCE TO NEAREST: WFLI-_ ft FOUNDATION—_, ft PROPERTY LINE ARTME#,.ft <br /> Q LIFT STATION SIZE —TYPE:OF PUMP D PKG TX PLANT Lu SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES 1_1 LEACHING CHAMBERS #OF LINES LENIGTH OF LINES �U , ft <br />_1, T y <br /> DISTANCE TO NEAREST WELL , ft FOUNDATION �,ft PROPERTY LINE�� ft <br /> FILTER BED WIDTII It LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> MOUNDED WIDTH _ ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST— WELL. ft FOUNDATION ft PROPERTY LINE It <br /> (l SUMPS WIDTH _ ft LENGTH ft DEPTH ft <br /> DISTANCE To NEAREST WELL Ft FOUNDATION ft PROPERTY LINE ft <br /> 0 DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft <br /> SEEPAGE PITS NUMBER 1 WIDTH -- ft DEPTH > ft <br /> DISTANCE_TO NEAREST WELL b ft FOUNDATION JU � b ft PROPERTY LINE� _,�. ft <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORTS WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MAUI 48 HOLlII;ADVANCE NOTICE REQ UIRfED FOR INSPECTIONS - PLEASE CALL L. (2 9)953-7697 <br /> SIGNED TITLE e--F}' DATE <br /> 41 <br /> -- — — — -- -- DEPARTAIENTYJSEIONLY <br /> Application Accepted B% _— Date 7,111h. Area _ � F_mployee ID# <br /> Final Inspection By_ Date LI S 1 OF PEC AIT-Approved by <br /> Character of Soil to Depth of 3 Fr.: —__._--- Pit/Sump Soil Character: <br /> CONVENTS <br /> Received Chec Amoun Permit)----_ Date Invoice# Permit ID# <br /> Code INFO B 1 ash emlS:ted _ Service Requt#es —_ <br /> UY7�w­J-16-11—w- <br /> 42-m ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />