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CITY/STATE/ZIP 0 d 6-5 ri) a4 <br />,(29--(e/72 -3 G0,5? <br />( <br />(-90cic3 3 3E6 <br />CITY/STATE/ZIP <br />PHONE <br />PHONE <br />( <br />cicco A2-/ 3 / A LICENSE E 1C-42 E IC-36 OTHER NUMBER EXPIRATION DATE <br />LAND USE APPLICATION # BUILDING PERMIT # <br />C OTHER 0 COMMERCIAL, <br />NUMBER OF BEDROOMS: 1)4- <br />RESIDENCE INSTALLATION WILL SERVE: <br />NUMBER OF LIVING UNITS: NUMBER OF EMPLOYEES: <br />WATER TABLE DEPTH: <br />PERC TEST # <br />ft GEOGRAPHICAL INFORMATION: Coordinates X <br />I I NEW INSTALLATION ) <br />REPLACEMENT ii, 1,1 I( <br />I I REPAIR/ADDITION <br />I I OUT-OF-SERVICE SEPTIC SYSTEM <br />ENGINEER DESIGNED /ALTERNATIVE <br />DESTRUCTION -S '( k El <br />TYPE OF WORK: <br />FOUNDATION ft PROPERTY LINE ft <br />ft DEPTH ft <br /> <br />ft DEPTH ft <br />FOUNDATION <br /> <br />ft PROPERTY LINE <br />ft <br />FOUNDATION ft ft PROPERTY LINE <br />-e (2- <br /> ft0)21.1e4IT <br />De ,.'/frett <br />0 C 2020 <br />VC 1%44 <br />'46-41 <br />$4,1 <br />DEPARTMENTc/SONLY <br />Application Accepted By 2--Z.- Date /We.? '/O Area d/q9 Employee ID# DA <br />Final Inspection By Date (1 E SPECIAL PERMIT - Approved by <br />Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br />COMMENTS Fcillule cCfad< SY5tt'6lv7. <br />PE <br />Code <br />SC <br />INFO <br />Received 2i )_,z Check#/Amount <br />Remitted Date Permit/ <br />Service Request # Invoice # Permit ID# av <br />'-ii O S- d elD -K1 30 Int-11D Sg ON ;b g g <br />ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 42-01 <br />4/14/18 :SS311UUV HIIS CROSS STREET IA) i I 01 61 ( f 11 APN 0 F7PODS-- <br />OWNER NAME 6 e (1121/ A-S *e A <br />(1 OWNER ADDRESS <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 (000 C (iv CITY/ZIP _iSt(1,C,./ <br />PARCEL SIZE 3 6 <br />CONTRACTOR alai-A /5' <br />CONTRACTOR ADDRESS <br /> I/0/ 11) S <br />IA <br />0 <br />0 <br />SEPTIC TANK <br />GREASE TRAP <br />LIFT STATION <br />TYPE/MFG ,)--t <br />TYPE/MFG <br />DISTANCE TO NEAREST: <br />SIZE TYPE <br />WELL e ft <br />OF PUMP <br />0 LEACH LINES 1 LEACHING CHAMBERS <br />DISTANCE TO NEAREST WELL ft <br />FILTER BED WIDTH ft LENGTH <br />DISTANCE TO NEAREST WELL ft <br />0 MOUNDED WIDTH ft LENGTH <br />DISTANCE TO NEAREST WELL ft <br />0 SUMPS WIDTH ft LENGTH <br />DISTANCE TO NEAREST WELL ft <br />U DISPOSAL PONDS WIDTH ft LENGTH <br />DISTANCE TO NEAREST WELL ft <br />0 SEEPAGE PITS NUMBER WIDTH <br />DISTANCE TO NEAREST WELL ft <br /># OF LINES <br /> <br />LENGTH OF LINES ft <br />FOUNDATION ft PROPERTY LINE ft <br />ft DEPTH ft <br />FOUNDATION ft PROPERTY LINE ft <br />ft DEPTH ft <br />FOUNDATION ft PROPERTY LINE ft <br />ft DEPTH ft <br />CAPACITY /on gal # OF COMPARTMENTS <br />CAPACITY gal # OF COMPARTMENTS <br />FOUNDATION 1 ft PROPERTY LINE ft <br />PKG TX PLANT 0 SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />SIGNED - <br />I HEREBY CE <br />(MINI <br />Y 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 />R ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 <br /> TITLE 0 W 1/4002 DATE