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<br />INSTALLATION WILL SERVE: RESIDENCE 0 COMMERCIAL <br /> <br />NUMBER OF LIVING UNITS: j'e NUMBER OF BEDROOMS: NUMBER 0 <br />a SEPTIC TANK TYPE/MFG C./ CAPACITY Z gal # OF COMPARTMENTS <br />U GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS <br />DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE •••••••st.., ft <br />U LIFT STATION SIZE TYPE OF PUMP PKG TX PLANT 0 SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />Si LEACH LINES 0 LEACHING CHAMBERS # OF LINES . 2...... LENGTH OF LINES <br />V° <br />ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />U FILTER BED WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY UNE ft <br />U MOUNDED WIDTH ft LENGTH ft DEPTH ft <br />WELL ft FOUNDATION ft PROPERTY UNE ft <br />"Cl SUMPS <br />DISTANCE TO N,REST <br />WIDTH ft LENGTH / ft DEPTH /7 ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />U DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY UNE ft <br />U SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />TYPE OF WORK: NEW INSTALLATION REPAIR/ADDMON <br />ENGINEER DESIGNED /ALTERNATIVE • - <br />REPLACEMENT n OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <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 />"2-c5 7 5-4-7 Cf:).41.-.4.-- Crre/ZiR <br /> AP N ?/9ÔC I IdEL SIZE 25--4 7,1 <br />e-t)6S t PHONE 3-8 , 4, <br />OWNER ADDRESS 4 0 crryisTATEIzip Yfr-2_3 <br />CONTRACTOR f1 k Sj4. /' PHONE <br />CONTRACTOR ADDRESS /4"/".:, CITY/STATE/ZIP <br />JOB ADDRESS <br />CROSS STREET <br />OWNER NAME <br />LICENSE 03C-42 0 :IC-36 OTHER fI NUMBER 2'.'i3 EXPIRATION DATE //y ( <br />lik/C) WATER TABLE DEPTH: 'I-0 <br />0 PERC TEST # <br />ft GEOGRAPHICAL INFORMATION: Coordinates x <br />BUILDING PERMIT # LAND USE APPLICATION # <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 1SS3111:1C1V 31IS a PAYMENT <br /> RECEIVED <br />EB 1 2 2021 <br /> JOAQUIN COUNTY <br />NVIRON MENTAL <br />HEALTH DEPARTMENT <br />( Date Employee ID# Area <br />FARTMENT USE ONLY <br />0 SPECIAL PERMIT - Approved by <br />acter: <br />1411 ) <br />,cc-ect2 <br />PE <br />Code <br />Sc <br />INFO <br />I Received Check#/ <br />„...-- <br />Amount <br />Remitted <br />Permit/ a e 1/(ervice Request # Invoice # Permit ID# <br />1 LfZ-( i - 1 I ( <br />142/1 <br />L <br />Pa§h <br />t7s5 3 co 7/vgLt.),-6 -7 ci <br />42-01 <br />4/14/18 <br />ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />SAN <br />9 I Application Accepted By <br />Final Inspection By A ' 4, c- Date <br />Character of Soil to Depth of 3iFt: <br />COMMENTS Rp.2(0_ces (71 stp-4-:c .P, <br /> <br />Il .... <br /> <br />i A' 5 P.-k..._ 19 a c k_ --(---0 tAle j r CO r &s' _