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JOB ADDRESS 1 7 - 4 -114 4- I 7.-'1 3 (. E. • 144-(2.4.4.L/ (...k) • cirri-zip (--0 V i '7 5-1 410 <br />CROSS STREET eh I3 / 1&b APN CMI*3 -24 0 - a-C PARCEL SIZE ii". k3 AC • <br />OWNER NAME XL. AIIVE-7)-1 1tu Di 7 AY2-D c /0 G. Co,2-6- E T>oxv i S- PHONE ( Car0 2-1 q -3.ft 3 <br />OWNER ADDRESS I77' -5 • tfV7C A.Jc kr. 27 <br />CONTRACTOR ove 0 PiN4 GED g Al I / I Ie-Div Arm, L <br />CONTRACTOR ADDRESS L7tO7 i.J. o Atic. c7 <br />ordsTATEmp cor)1 C A cry 2 4 b <br /> <br />PHONE 3 c 031ç <br /> <br />CITY/STATE/ZIP L-4>t, t Cd2t /S-2- ‘-‘ o <br /> <br />LICENSE C-42 C-36 OTHER C NUMBER r I EXPIRATION DATE - 3 0 - <br />A A <br />z <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 />WATER TABLE DEPTH: <br /> <br />ft GEOGRAPHICAL INFORMATION: Coordinates X <br /> <br />PERC TEST # BUILDING PERMIT # LAND USE APPLICATION # <br />TYPE OF WORK: NEW INSTALLATION <br />REPLACEMENT <br />REPAIR/ADDITION <br />OUT-OF-SERVICE SEPTIC SYSTEM <br />ENGINEER DESIGNED /ALTERNATIVE <br />' DESTRUCTION <br /> <br />INSTALLATION WILL SERVE: RESIDENCE - COMMERCIAL <br /> <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: <br />OTHER <br />NUMBER OF EMPLOYEES: <br />0 SEPTIC TANK TYPE/MFG CAPACITY gal # OF COMPARTMENTS <br />0 GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS <br />DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br />0 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 ft <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 />MINIMU 2LIFAANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209)953-7697 <br /> TITLE f/2-03 1,41 &le . DATE 3 2 (01 2.i SIGNED :SS-31113CW 31IS PAYMENT <br />RECEIVED <br />Z 9 2021 <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL <br />HEALTH DEPARTMENT <br />Application Accepted B <br /> <br />DEPARTMENTUSONL Y <br /> Date ?,/a) 4' a7) Area Ve? Employee ID# <br />Date p...0/2. I -] SPECIAL PERMIT -Approved by <br /> Pit/Sump Soil Cih;picter: <br />rt•rke--- • r.3 07 41 it'? Ch. <br /> <br />Final Inspection By <br />Character of Soil to Depth of 3 Ft: <br />COMMENTO-el) p erc, <br />PE <br />Code <br />SC <br />INFO <br />ReceivedCheck#/ Amount <br />Remitted Date Permit/ <br />Service Request # Invoice # Permit ID# <br />Lid Da -Ce2 3 <br />Av iree,/ <br />/ ti -02 .; '09124 SO 00 2.3 WI 21- <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4/14/18