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OWNER NAME />i2. C.)0 C46112-e-lf <br />OWNER ADDRESS SCI VP, <br />PHONE <br />CITY/STATE/ZIP <br />CONTRACTOR PHONE 1-eg 70 s-zt 3 <br />LAND USE APPLICATION # BUILDING PERMIT # PERC TEST # <br />ft <br />gal # OF COMPARTMENTS <br />gal # OF COMPARTMENTS <br />ft PROPERTY LINE <br />ft <br />ft <br />LENGTH OF LINES ft <br />ft PROPERTY LINE ft <br />DEPTH ft <br />ft PROPERTY LINE ft <br />DEPTH ft <br />ft PROPERTY LINE ft <br />DEPTH ft <br />ft PROPERTY LINE ft <br />DEPTH ft <br />ft PROPERTY LINE <br />ft DEPTH <br />ft PROPERTY LINE ft <br />SIGNED <br />MINIMU UR A VANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7. • 7 <br />TITLE C11---A1./.724-e17?71— DATE <br />IT K31 <br />(/ 2244 yiw trEc6.1 4- iv <br />Application Accepted <br />Final Inspection By <br />y <br />IV-111 °MINN* , :SS311fil1y 31IS WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X <br />TYPE OF WORK: NEW INSTALLATION <br />REPLACEMENT <br />0 REPAIR/ADDITION <br />0 OUT-OF-SERVICE SEPTIC SYSTEM <br />INSTALLATION WILL SERVE: 0 RESIDENCE <br />NUMBER OF LIVING UNITS: <br />COMMERCIAL <br />NUMBER OF BEDROOMS: <br />0 <br />0 <br />0 <br />SEPTIC TANK <br />GREASE TRAP <br />LIFT STATION <br />TYPE/MFG CAPACITY <br />TYPE/MFG CAPACITY <br />DISTANCE TO NEAREST: <br />SIZE TYPE <br />WELL ft FOUNDATION <br />OF PUMP U PKG TX PLANT U <br />0 LEACH LINES 0 LEACHING CHAMBERS <br />DISTANCE TO NEAREST <br /># OF LINES <br />WELL ft FOUNDATION <br />0 FILTER BED WIDTH ft LENGTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION <br />0 MOUNDED WIDTH ft LENGTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION <br />0 SUMPS WIDTH ft LENGTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION <br />0 DISPOSAL PONDS WIDTH ft LENGTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION <br />0 SEEPAGE PITS NUMBER WIDTH <br />DISTANCE TO NEAREST WELL ft FOUNDATION <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 />Jc,A , <br />-t7 witty <br />CLLN 11 00),4117 /7,11. <br />7)ttiv <br />SAN 2021 <br />7-V <br />DEPARTMENT USE ONLY <br />Date 041) / Area //qq <br />Date ,S / 2.0 0 SPECIAL PERMIT - Approved by <br />Employee ID# <br />Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br />COMMENTS C.--.411-ec € f t")-(3 -i-c-;7 kS Et1:- IFC)1 /41)1°,42 <br />0)(164Y- t) frt fre -c- v y--Ns <br />P‘.A3••• P\--9-kv - <br />PE <br />Code <br />SC <br />INFO <br />Received <br />By <br />Check#/ <br />Cash <br />Amount <br />Remitted Date Permit/ <br />Service Request # Invoice # <br />__.-1 <br />Permit ID# <br />ida a 1 Q76- ‘1/44- ,/-)ej,i-/- 4-1cD. *7 6/2/ -<:.-}c-00% -\\, <br />ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4/14/18 <br />42-01 <br />ENGINEER DEsinNpri TFP Al A TIVC <br />1%7-DESTRUCTION 14 t-e4 h ks <br />0 OTHER <br />NUMBER OF EMPLOYEES: <br />SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />JOB ADDRESS 2-51 2-44 c-e-yrif CITY/ZIP M- 9S-2-0.e <br />CROSS STREET APN /7/ —/ 7c, PARCEL SIZE <br />CITY/STATE/ZIP ..5729cycrexi 1 <br />NUMBER 9 i'-`-rt s& EXPIRATION DATE //4 -2-- "2--- <br />CONTRACTOR ADDRESS 6) /.3A'-e-& c„7-- <br />LICENSE 0 C-42 0 C-36 OTHER 6