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WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X <br />E PERC TEST # <br /> <br />BUILDING PERMIT # LAND USE APPLICATION # <br />TYPE OF WORK: O NEW INSTALLATION <br />D REPLACEMENT <br />REPAIR/ADDITION <br />OUT-OF-SERVICE SEPTIC SYSTEM <br />ENGINEER DESIGNED /ALTERNATIVE <br />DESTRUCTION CIf1rjL f- I 3 ,1 <br />INSTALLATION WILL SERVE: CI RESIDENCE <br />NUMBER OF LIVING UNITS: <br />[1 COMMERCIAL <br />NUMBER OF BEDROOMS: <br />IL OTHER <br />NUMBER OF EMPLOYEES: <br />, <br />0 <br />0 <br />SEPTIC TANK TYPE/MFG CAPACITY gal # OF COMPARTMENTS <br />GREASE TRAP TYPE/MFG 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 />0 LEACH LINES LEACHING CHAMBERS # OF LINES LENGTH OF LINES ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />0 FILTER BED WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />0 MOUNDED WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />0 SUMPS WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE <br />0 DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />0 SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL 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 />Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br />COMMENTS __:.L.e.444o-4- brmlo -or S <br />PE <br />Code <br />SC <br />INFO <br />Received <br />By <br />(Cfrleckty.) Amount <br />Remitted ,Da Permit/ <br />Service Request # Invoice # Permit ID# <br />Cash a <br />1 0 7s- AV-6' 1.13(lf 4 I <br />ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 42-01 <br />4/14/18 <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 INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />JOB ADDRESS / - 7 a FT, 1_,L.) 6, ,.-(_ CITY/ZIP 777/97.0-7-QC4 q,C Yr_z -7 <br />CROSS STREET i LS <br />OWNER NAME -(,), :/—' /4-//1-4) I /W, ‘(---- C /126t i /6,e),z_l_ s <br />APN 1919 LI)f) 3°F PARCEL SIZE <br />PHONE :SSAHUUlv. 311S OWNER ACDRESS <br />CONTRACTOR A-.) 6 <br />CONTRACTOR ADDRESS I7c--9C Li/0 3 <br />PHONE 42-C4i 47,-S <br />CITY/STATE/ZIP 217 ',V r'•-:/-) S ( <br />13/3f/R 1 <br />CITY/STATE/ZIP <br />LICENSE [11 C-42 a ]C-36 OTHER NUMBER iCt)q.3 S .C./ EXPIRATION DATE <br />SIGNED <br />MINI UM 48l/Q2AfiVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209)953-7697 <br />— TITLE DATE <br />LI <br />Y <br />hi <br /> Ai4M/Yii, /4/ <br />20.21 <br />r ev,..1,„ uk4 Ivry <br />lip 7- <br />47,41/, a 0 <br />DEPARTMENT USE ONLY r4", <br />Application Accepted By .'"---r-7- --"_----7/--.2-- Date 3/9 /0) i Area CAY141/1CC6' Employee ID# <br />Final Inspection By V \ (,4.3.,, (12‘..,-(..- ...1,.1., .i 1104\ E SPECIAL PERMIT -Approved by Date <br />PA