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o55 ,:311 JOB ADDRESS ITY/ZIP <br />PARCEL SIZE <br />PHONE 5V 49,42.2. <br />APN LI 3 L1 33 <br />BUILDING PERMIT # LAND USE APPLICATION # <br />0 a- ,1 —45 <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 CAL (209)953-7697 FOR IN ECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />CONTRACTOR Yet e 5 <br />CONTRACTOR ADD ESS /10 )7,2-9 <br />LICENSE eC-42 0 DC-36 OTHER NUMBER ViiggEXPIRATION DATE -I - 3/ <br />ft GEOGRAPHICAL INFORMATION: Coordinates X WATER TABLE DEPTH: <br />0 PERC TEST # <br />REPAIR/ADDITION t: ENGINEER DESIGNED /AVERNATIVE <br />OUT-OF-SERVICE SEPTIC SYSTEM iv DESTRUCTION it::14 <br />0 RESIDENCE 0 COMMERCIAL I 0 OTHER <br />NUMBER OF BEDROOMS: LI ftl NUMBER OF EMPLOYEES: <br />SEPTIC TANK TYPE/MPG y //For welt' a CAPACITY )-5Z2 <br />• <br />gal <br />GREASE TRAP TYPE/MFG <br />DISTANCE TO NEAREST: WELL 4 I/ e— ft FOUNDATION <br />LIFT STATION SIZE <br /> f <br />TYPE OF UMP PKG TX PLANT U SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />TITLE DATE <br />CROSS STREET 4 <br />OWNER NAME "." e C. <br />OWNERADDRESS r1/4 C e cr.sTATE,z,p 73-4 C7i C ea Y.C.1G <br />PHONE 21-‘392 <br />.cinisTATEIzip fy <br />TYPE OF WORK: I NEW INSTALLATION ) <br />A REPLACEMENT 6111 K <br />INSTALLATION WILL SERVE: <br />NUMBER OF LIVING UNITS: <br />CAPACITY <br /># OF COMPARTMENTS <br />gal # OF COMPARTMENTS <br />ft PROPERTY LINE 2 -4" ft :Ssallaay 31IS SIGNED <br />5 <br />e., <br />42-01 <br />4/14/18 <br />ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> FEB 1 6 2021 <br />EpARTmeArr <br />SAN <br />L. <br />EPARTMENT U <br />Application Accepted By Date ' <br />L DS1 ONLY <br />4.i <br />I <br />A- / Area S; Employee ID# As <br />Final Inspection By Date 0 SPECIAL PERMIT - Approved by <br />Character of Soil to Depth of 3 Ft: Pit/Sump S il Character: _ <br /> eV <br />V"e <br />PE <br />Code <br />SC <br />INFO <br />Received <br />1.ity, <br />(Check Amount Amount <br />Remitted Date Permit/ <br />Service Requesi# Invoice # Permit ID# <br />W VI I IS- Z„1/9— <br />Cosy <br />2L3 43 'k3 ,2•11( IA SQP0t3Zt3 <br />COMMENTS