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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - Srocrorom CA 95205 - (209)468-3420 <br />NON-REFUNDABLE PERMIT CALL (209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />JOB ADDRESS _1„59,_3_i_,..s eF_Aa14._ cirdzip s sce, iewl c.:41 '53 _7 ., 7.110 <br />CROSS STREET LI.D11 E.. -rr e P APN L-20S-31--100.S— PARCEL szE Lig. /-.5 <br />OWNER NAME L a i 7 UN) 0 I i if r <br />OWNER ADDRESS i , Li g ..7 <br />CONTRACTOR ill ,. i(i e„„s__ - . ' - ‘4...1.44 a•-e- S7t •'' PHONE 4,9- <br />CONTRACTOR ADDRESS lb J,-./ tps 0, CITY/STATE/ZIP 01, cr4,i-e,- .4 )404' <br />LICENSE LI C-42 Li _ C -36 OTHER 4- <br />NUMBER &YA:.151-1 EXPIRATION DATE <br />PHONE <br />Cry/STATE/Zip 311 Ci f.) <br /> <br />INSTALLATION WILL SERVE: VRESIDENCE <br /> <br />NUMBER OF LIVING UNITS: <br />E COMMERCIAL <br />NUMBER OF BEDROOMS: ,2.? <br />E OTHER <br />NUMBER OF EMPLOYEES: <br />WATER TABLE DEPTH: FO -go ft GEOGRAPHICAL INFORMATION: Coordinates X <br /> <br />PERC TEST # <br /> <br />BUILDING PERMIT # /414Vit (d, LAND USE APPLICATION # <br /> <br />TYPE OF WORK: NEW INSTALLATION <br />REPLACEMENT <br />_ REPAIR/ADDITION <br />_ OUT-OF-SERVICE SEPTIC SYSTEM <br />ENGINEER DESIGNED /ALTERNATIVE <br />_ DESTRUCTION <br /> <br /># OF LINES ________ LENGTH OF LINES SITS ft <br />WELL 1 3 . 1 1 ft PROPERTY LINE (5 0 ft <br /> ft DEPTH ft <br />ft FOUNDATION ft PROPERTY LINE ft <br />ft LENGTH ft DEPTH ft <br />WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ft DEPTH ft <br />ft FOUNDATION ft PROPERTY LINE ft <br />ft LENGTH ft DEPTH ft <br />ft FOUNDATION ft PROPERTY LINE ft <br />ft DEPTH 3,6 1 ft <br />WELL i 561 ft FOUNDATION 2;.' ft PROPERTY LINE t' 1 ft <br />gl.---SeEPTIC TANK <br />GREASE TRAP <br />LIFT STATION <br />LINES <br />FILTER BED <br />MOUNDED <br />SUMPS <br />DISTANCE TO NEAREST <br />WIDTH <br />DISTANCE TO NEAREST <br />WIDTH <br />DISTANCE TO NEAREST <br />WIDTH <br />DISTANCE TO NEAREST <br />DISPOSAL PONDS WIDTH <br />SEEPAGE PITS <br />I- LEACHING CHAMBERS <br />ft FOUNDATION <br />ft LENGTH <br />WELL <br />ft LENGTH <br />WELL <br />DISTANCE TO NEAREST WELL <br />NUMBER ‘3 <br />DISTANCE TO NEAREST <br />WIDTH i..4 .?.4‘ <br />TYPE/MFG <br />TYPE/MFG <br />DISTANCE TO NEAREST: WELL toO ft <br />SIZE TYPE OF PUMP <br />CAPACITY 162 -6C gal # OF COMPARTMENTS <br />CAPACITY gal # OF COMPARTMENTS <br />FOUNDATION ft PROPERTY LINE ft <br />PKG TX PLANT 0 SAND OIL SEPARATOR (ENCLOSED SYSTEM) :SS3111:113V 311S ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <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 />MINIMUM 48 HO DVANCENOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209)p3-l6 <br />SIGNED TITLE N-445. r DATE ,97) 4-1 <br />DEPARTMENT gSE.ONLY <br />Application Accepted By Date hiP,3/2 ..:30 Area q Employee ID# <br />Final Inspection By 01315-1V,^ Date -0% 1 1.5 ttOZ.\ I: SPECIAL PERMIT -Approved by <br />Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br />COMMENTS pie v\1 FR. ),er J1.i\-) ti4 /-1 S 1-64 ,CkS e 'E /-/L <br />PE <br />Code <br />SC <br />INFO <br />Received (ChecJs/Al" <br />:ash <br />Amount <br />Remitted Date Permit/ <br />Service Request # . Invoice # Permit ID# <br />HD/1 1)7 <br />j.....219___ <br />` /76,8T4,19 l77'1• Ga 00 MO9-1 / <br />42-01 " ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4114/18 (!) V:-.3 S,..kos./.. ° 1 Z.A