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0 PERC TEST # <br />TYPE OF WORK: <br /> <br />BUILDING PERMIT # LAND USE APPLICATION # <br />I.: NEW INSTALLATION IC 0 ENGINEER DESIGNED /ALTERNATIVE <br />12 REPLACEMENT U 0 DESTRUCTION <br />REPAIR/ADDMON <br />OUT-OF-SERVICE SEPTIC SYSTEM <br />CiTy/ZiP <br />APN 061 D UI 0 3 PARCEL SIZE 69s-- <br />PHONE <br />DEPARTMENTIS ONLY <br /> Date <br />Date -b1 o SPECIAL PERMIT - Approved by <br /> Pit/ ump Soil Character: —r. /40t4ells v.1 <br />Area LI ei Employee ID# <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 CALL (209) 953-7697 FOR SPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />JOB ADDRESS <br />CROSS STREET <br />OWNER NAME V-I2 1•111/.1 ic.";s- <br />99' .1./erfr.c. <br />OWNER ADDRESS <br /> <br />CITY/STATE/ZIP <br />CONTRACTOR 0241dra 1/Q 1/t Xe"C-PHONE V°141)49' <br />CONTRACTOR ADDRESS di 6. AT.p4fio 161.e_ Ar CITY/STATE/ZIP <br />VC-P0 iff.E.XPIRATION DATE 9/3 <br />WATER TABLE DEPTH: 0 -487 ft CEOGRApHicAL INFORMATIoN: Coordinates X <br /> <br />INSTALLATION WILL SERVE: RESIDENCE 0 COMMERCIAL <br /> 0 OTHER <br /> <br />NUMBER OF LIVING UNITS: - NUMBER OF BEDROOMS: <br /> <br />NUMBER OF EMPLOYEES: <br />LICENSE IX-42 0 -2c-36 OTHER <br /> <br />NUMBER <br />-Sbc27 <br />a :ssaucial, muS SEPTIC TANK TYPE/MFG <br />GREASE TRAP TYPE/MFG <br />CAPACITY gal # OF COMPARTMENTS <br />CAPACITY gal # OF COMPARTMENTS <br />DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br />LIFT STATION SIZE TYPE OF PUMP PKG TX PLANT 0 SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br /> # OF LINES LENGTH OF LINES S-0 f ft <br />ft FOUNDATION ft PROPERTY LINE so , ft <br />ft LENGTH DEPTH ft <br /> ft FOUNDATION ft PROPERTY LINE It <br /> ft DEPTH ft <br /> ft FOUNDATION ft PROPERTY LINE ft <br />ft LENGTH ft DEPTH ft <br /> <br />ft FOUNDATION ft PROPERTY LINE ft <br />ft LENGTH ft DEPTH ft <br /> <br />FOUNDATION ft PROPERTY LINE ft <br />WIDTH .5- ft DEPTH 1S - ' ft <br /> <br />FOUNDATION VO # ft PROPERTY LINE ,70 . 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 />MINIMUM 48 HOUR ADVANCE NQICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209)953-7697 <br />0 LEACHING CHAMBERS <br />DISTANCE TO NEAREST <br /> <br />WIDTH <br />DISTANCE TO NEAREST <br /> <br />WIDTH <br />DISTANCE TO NEAREST <br /> <br />WIDTH <br />DISTANCE TO NEAREST <br />El DISPOSAL PONDS WIDTH <br />DISTANCE TO NEAREST <br />SEEPAGE PITS NUMBERcc? ) <br />DISTANCE TO EAREST <br />LEACH LINES <br />CI FILTER BED <br />Li MOUNDED <br />I0 SUMPS <br />WELL /* <br />WELL <br />ft LENGTH <br />WELL <br />WELL <br />WELL It <br />WELL 0 # ft <br />SIGNED TITLE DATE 3 -G7 1 <br />16 <br />Application Accepted BK <br />Final Inspection By R • <br />Character of Soil to Depth of 3 Ft: <br />COMMENTS, 5yll s-tri <br />Re ,SS <br />PE <br />Code <br />SC <br />INF° <br />Received <br />111yel <br />eck <br />ash <br />Amount <br />Remitted Date Permit/ <br />Service Request # Invoice # Permit ID# <br />i-id10 Hs' eat"-- 2- 1-24, *.300 S12- 2,1 S 12002'33(k; <br />42-01 <br /> <br />ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4/14/18