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INSTALLATION WILL SERVE: 0 RESIDENCE <br />NUMBER OF LIVING UNITS: <br />El COMMERCIAL <br />NUMBER OF BEDROOMS: <br />0 OTHER <br />NUMBER OF EMPLOYEES: <br />/2-0BEg--70 .S./Arnib'6V L <br />JOB ADDRESS <br />CROSS STREET pkwi 1 i E APN 0 02-0 - I <br />OWNER NAME <br />4,1-84s- 1-1-11-PiEsi — R. CITY/ZIP A-cikM P 9 5--2,-(.) <br />crrysTATErzip ip(L -r cA Cj5,32_ -5 )c iyy OWNER ADDRESS <br />1-tv'C cltk3& G- U\S rzo Cnri- PHONE CONTRACTOR <br />CITISTATE/ZiP LODI CA .5-2-s c4 CONTRACTOR ADDRESS 40 VI..) • 07N1G—. $T • <br />LICENSE QC-42 QC-36 OTHER NUMBER EXPIRATION DATE <br />ft GEOGRAPHICAL INFORMATION: Coordinates X <br />BUILDING PERMIT # LAND USE APPLICATION # <br />TYPE OF WORK: NEW INSTALLATION <br />REPLACEMENT <br />C REPAIR/ADDITION <br />0 DESTRUCTION <br />C ENGINEER DESIGNEE /ALTERNATIVE <br />UP,I1 I C VVAb I tVVA I tk I KtA IMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET • STOCKTON CA 95202 -(209) 468-3420 <br />NON-REFUNDABLE PERMIT CALL (209) 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />WATER TABLE DEPTH: <br />PERC TEST # <br />PARCEL SEE • 0 <br />PHONE C IS-° <br />Application Accepted By <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />5 <br />r <br />I <br /> 142vs <br />2.8 2019 <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL. <br />BEA TN DEPARTMENT <br />(-\ <br />DEPARTMENTI,SE ONL <br /> Date Z— 7.5" (-( Area <br />0 SPECIAL PERMIT -Approved by <br />PitISump Soil Character: <br />COMMENTS <br />PE <br />Code <br />SC <br />INFO <br />Received <br />qY 1 <br />Check#/ <br />Cash <br />Amount <br />Remittsd, Date Permit/ <br />Service Request # Invoice # Permit ID# <br />1 5-z-- 2froq SP o.0 gb .2.7.0 <br />Employee ID# <br />- <br />Date Date <br />Character of Soil to Depth of 3 Ft <br />Final Inspection By :SS-3110 CIV 31IS SEPTIC TANK TYPE/MFG <br />GREASE TRAP TYPE/MFG <br />CAPACITY gal # OF COMPARTMENTS <br />CAPACITY gal # OF COMPARTMENTS <br />DISTANCE TO NEAREST: WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />LIFT STATION SIZE TYPE OF PUMP <br /> <br />PKG TX PLANT <br /> <br />O SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />LEACH LINES 0 LEACHING CHAMBERS <br /># OF LINES LENGTH OF LINES ft <br />DISTANCE To NEAREST WELL <br /> <br />ft FOUNDATION ft PROPERTY LINE ft <br />FILTER BED WIDTH __ ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />MOUNDED WIDTH ft LENGTH <br />ft DEPTH ft <br />DISTANCE To NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />SUMPS WIDTH ft LENGTH <br />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 FOUNDATION ft PROPERTY LINE ft <br />SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL <br /> ft FOUNDATION ft PROPERTY LINE ft <br />I HEREBY CERTIFY THAT 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 />SIGNED <br />K <br />TITLE CS iv5 )LflAJT DATE 2" / <br />MINIMUOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 <br />;;D °- <br /> ymEHT <br /> RECEIVED