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E vEa cirdzip (2- Pe P5-2(06, JOB ADDRESS <br />CROSS STREET tN) fiVGIVER- 12-P <br />OWNER NAME S1Eri M Cc L tAk <br />APN Lt. 01:3 PARCEL SIZE <br />PHONE <br />PHONE <br />CITY/STATE/ZIP a-IAN cA 957 <br />(q2s) 9-340- g <br />LAND USE APPLICATION # <br />WATER TABLE DEPTH: <br />E PIERC TEST # BUILDING PERMIT # <br />ft GEOGRAPHICAL INFORMATION: Coordinates X <br />ito pqr+ Lel Sr <br />D ORA SrP1-7- E Cori Sr reAK-ri av <br />OWNER ADDRESS <br />CONTRACTOR <br />t2 fi,vE 30 <br />LICENSE 0 C-42 OliC-36 OTHER NUMBER 65896 ( <br />IN MIT 911Sci <br />63/ 711 <br />CONTRACTOR ADDRESS CITY/STATE/ZIP <br />EXPIRATION DATE <br />ft PROPE ..4)0->, ft <br />LI ENGINEER A DESIGNED‘LTERNATIVE <br />DESTRUCTION sep c <br />E OTHER <br />NUMBER OF EMPLOYEES: <br />gal # OF COMPARTMENTS <br />gal # OF COMPARTMENTS <br />ft PROPERTY LINE <br />SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />ft <br />ft <br />ft <br />LENGTH OF LINES <br />DEPTH <br />DEPTH <br />DEPTH <br />PROPERTY LINE PANL__ <br />PROPERTY LINE <br />PROPE I EEP <br />AlQui N O <br />Pe.c `iv?' it <br />ft <br />0 8 2020 f tft <br />47 lie <br />0 ft <br />ft <br />ft <br />ft <br />C' ' itY0A/m <br />DEPTH ft ft <br />ft PROPERTY LINE ft <br />ft DEPTH <br /> <br />ft <br />ft PROPERTY LINE ft <br />DEPARTMENT ,LIE ONLY <br />Application Accepted B A flatP C/78/0200/0 Area 11/ei Employee ID# DA1 <br />Final Inspection By <br />Character of Soil to Depth of 3 Ft: <br />COMMENTS <br />0 SPECIAL PERMIT - Approved by Date io/g/ZoLo <br />Pit/Sump Soil Character: <br />PE <br />Code <br />SC <br />INFO <br />Received <br />B <br />Check#/ <br />Cash <br />Amount <br />Remitted Date Permit/ <br />Service Request # Invoice # Permit ID# <br />Lida I 075- a ,De.bi--i- fis-,9 *fro suoN2r-Je <br />42-01 <br />4/14/18 6A-P n376.) g,S7 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 />NON-REFUNDABLE PERMIT <br /> <br />CALL (209) 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED :SSMIIICIV 311S TYPE OF WORK: I I NEW INSTALLATION <br />REPLACEMENT <br />REPAIR/ADDITION <br />OUT-OF-SERVICE SEPTIC SYSTEM <br />INSTALLATION WILL SERVE: E, RESIDENCE <br />NUMBER OF LIVING UNITS: <br />COMMERCIAL <br />NUMBER OF BEDROOMS: <br />0 <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 0 PKG TX PLANT 0 <br />0 LEACH LINES LEACHING CHAMBERS <br />DISTANCE TO NEAREST <br /># OF LINES <br />WELL ft FOUNDATION <br />0 <br />0 <br />FILTER BED <br />MOUNDED <br />WIDTH ft LENGTH ft <br />DISTANCE TO NEAREST <br />WIDTH <br />WELL <br />ft <br />ft FOUNDATION <br />LENGTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION <br />0 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 ft FOUNDATION <br />0 SEEPAGE PITS NUMBER WIDTH <br />DISTANCE TO NEAREST WELL ft FOUNDATION <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 TITLE O"IN/ fiL DATE 202-0 <br />MIN7UM 48 1-),‘,1 ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-1697 <br />fi <br />sf,