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ONSITE WASTEWATER TRTMNT S4 <br />e.><7 <br />M PERMIT <br />5 -71-6,44- e?( -6ei/tq <br />WATER TABLE DEPTH: <br />fl PERC TEST # <br />DISPOSAL PONDS WIDTH ft LENGTH <br />DISTANCE TO NEAREST WELL <br />SEEPAGE PITS NUMBER <br />SUMPS WIDTH ft LENGTH <br />DISTANCE TO NEAREST WELL <br />DISTANCE To NEAREST <br />FILTER BED WIDTH <br />DISTANCE TO NEAREST <br />MOUNDED WIDTH <br />DISTANCE TO NEAREST <br />LEACH LINES LEACHING CHAMBERS <br />DISTANCE TO NEAREST WELL FOUNDATION <br />WELL <br />ft LENGTH <br />WELL <br />ft LENGTH <br />WELL <br /> # OF LINES LENGTH OF LINES ft <br />ft FOUNDA I ION It PROPERTY LINE ft <br /> ft DEPTH ft <br /> ft FOUNDATION ft PROPERTY LINE ft <br /> <br />ft DEPTH ft <br /> ft FOUNDATION ft PROPER I Y LINE ft <br /> <br />ft DEPTH ft <br />Ft FOUNDATION ft PROPERTY LINE ft <br /> ft DEPTH ft <br /> ft FOUNDATION ft PROPERTY LINE ft <br />WIDTH ft DEPTH ft <br />ft ft PROPERTY UNE ft <br />ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAzELTON AVENUE SToCKToN CA95205 - (209)468-3420 NON -REFUNDABLE PERMIT CALL (209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />CRoSs STREET Orr <br />Omen NAME VOA IblAV r11104 <br />OWNER ADDRESS &AMC- 01-S i2V)0Ye, <br />PHONE <br />CITY/STATE/ZIP <br />LICENSE -C-42 E C-36 OTHER 14 NUMBER 251 IS1 EXPIRATION DATE <br />JOB ADDRESS 34-27- S. In and DY. n CIrriZIP &17e.-Y-11An <br />APN <br />PARCEL SIZE <br />PHONE <br />CITY/STATE/ZIP <br />CONTRACTOR v\iesi- 0,Dast <br />CONTRACTOR ADDRESS 1\11o..X. 1k1 st • <br />VA • 3-3. /394 <br />Lt cti Crt 952-4D <br />2-07_3 <br />LAND USE APPLICATION # BUILDING PERMIT # <br />REPAIR/ADDMON <br />_ OUT-OF-SERVICE SEPTIC SYSTEM <br />ENGINEER DESIGNED /ALTERNATIVE <br />DESTRUCTION <br />ft GEOGRAPHICAL INFORMATION: Coordinates X <br />TYPE OF WORK: NEW INSTALLATION <br />/** REPLACEMENT ittrt <br />INSTALLATION WILL SERVE: <br />NUMBER OF LIVING UNITS: <br />E RESIDENCE 0 COMMERCIAL <br />NUMBER OF BEDROOMS: <br />E OTHER <br />NUMBER OF EMPLOYEES: <br />CAPAcrTy <br />CAPACITY gal # OF COMPARTMENTS <br />ft PROPERTY LINE It <br />0 SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />Z. SEPTIC TANK TYPE/MFG <br />GREASE TRAP TYPE/MFG <br />MOO <br />gal tt OF COMPARTMENTS 2- <br />DISTANCE TO NEAREST: WELL ft FOUNDATION <br />LIFT STATION SIZE TYPE OF PUMP PKG TX PLANT <br /> <br />1 . <br />SIGNED A lvd.,e4--t 'La r...- TITLE t'cyl-- einkrr mailf DATE I4 j .2-( <br />I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br />MIN r In 18 HOW? ADVANCE NOTICE RE_QUIRED FOR_INSPECtIONS - PLEASE CALL (209) _ 7 STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br />'W4 <br />Al <br /> 411.4R <br />2 3 2o2i <br />cou <br />j41°6,04^17.7:41LA ,4,74r <br />Area Employee Ilati <br />E SPECIAL PERMIT - Approved by <br />C erecter: <br />Application Accepted <br />DEPARTMENT USE ONL Y <br /> Date • . • <br />Date V2, 1 Final Inspection By <br />Character of Soli to Depth of 3 Ft: <br />COMMENTS te iC <br />,• <br />by <br />0(r W-C -1-4.1)K <br /> <br />(e (-L <br />- ) 122-577 , <br />leck-ci? '\.1q .be_' 9 ; o_r <br /> <br />t`i vt1ç-ter- cI43 co 12,v) / 01 <br />Pit/ mp So' <br />42-01 <br />4/14/18 <br />eiktf-D <br />Lte-e,-s <br />-et-et -fro PE <br />Code <br />SC <br />INFO <br />Received Check Amount <br />Remitted Date <br />. - „ — _ . .. <br />' Permit/ <br />Service Request # invoice # Permit ID# /71_1 ji: .Cas" ..4., <br />_