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NON-REFUNDABLE PERMIT <br />JOB ADDRESS 6-, 6 ca ( <br />CROSS STREET /4-1 le,.) APN —2 -° ? 2 0 PARCEL SIZE / <br />CALL (209) 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />A re Fe/00 (L CITY/ZIP //'(-- 5)) Yu V <br />A <br />OWNER NAME /- /1 PHONE :SSMICICIV 311S LICENSE L1C-42 OC-36 OTHER J/2 / A NUMBER EXPIRATION DATE <br />WATER TABLE DEPTH: do -30 ft GEOGRAPHICAL INFORMATION: Coordinates X <br />REPAIR/ADDITION Li ENGINEER DESIGNED /ALTERNATIVE CI NEW INSTALLATION <br />Li REPLACEMENT <br />TYPE OF WORK: <br />E COMMERCIAL OTHER <br /> <br />INSTALLATION WILL SERVE: V RESIDENCE <br /> <br />NUMBER OF LIVING UNITS: / NUMBER OF BEDROOMS: 2.NUMBER OF EMPLOYEES: <br />BUILDING PERMIT # LAND USE APPLICATION # <br />r1 OUT-OF-SERVICE SEPTIC SYSTEM 0 DESTRUCTION <br />PERC TEST # <br />-,'" ---- <br />PAYm <br />RE EN COVE. <br />PR ii <br />2 7 202 8/AN Qiam, <br />viR0A, <br />nikle <br />COuk <br />vr " <br />r7 ARrh. miriv <br />DEPARTMENT USE ONLY <br />Application Accepted By - Date `-//i Area 51ci 611 Employee ID# A( <br />Final Inspection By AMA Date "k L." k SPECIAL PERMIT Approved by <br />Character of Soil to Depth of 3 Ft: r-IPoserl LtAk..". Pit/Sump Soil Character: <br />COMMENTS F€i1i Sych'm E,t),si-11) imrs "to r PtrAill • Rib)) tAioter- __y <br />PE <br />Code <br />SC <br />INFO <br />Received Check#/ Amount <br />Remitted Date Permit/ <br />Service Request # Invoice # Permit ID# <br />1-131° 11 5- VW <br />CasZ7 / <br />L'1) ,a -t30-0 '-i-'11.21 5a 00nL9 IC <br />ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 42-01 <br />4/14/18 <br />ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 -(209) 468-3420 <br />OWNER ADDRESS Ci <br /> CITY/STATE/ZIP <br />CONTRACTOR eqk S-er e <br /> <br />PHONE 7c) 7 —7)— (-/T3 I <br />CONTRACTOR ADDRESS /• //d <br /> <br />CITY/STATE/ZIP C_ 4 , <br />SEPTIC TANK TYPE/MFG CAPACITY gal # OF COMPARTMENTS <br />GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS <br />DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE <br /> <br />ft <br />LIFT STATION SIZE TYPE OF PUMP Q PKG TX PLANT 0 SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />Li LEACH LINES LEACHING CHAMBERS # OF LINES LENGTH OF LINES ft <br />eg FILTER BED WIDTH / 0 ft LENGTH 6 v. ft DEPTH ..de ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />DISTANCE TO NEAREST WELL ---6- ft FOUNDATION .3' .-:.>' ft PROPERTY LINE ft <br />MOUNDED WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />SUMPS WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE <br />Li 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 />M!NIMUM ,48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209)953-7697 <br />SIGNED /7" _ TITLE DATE 2 ?/ 2 (