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JOB ADDRESS cn-yrzip LCD t9ç2w [06 2 E. I4ETTL E . <br />OWNER NAME PHONE 3 2-1- 14 S-3 DEL-Tet Pfc.-/ ni ( aerz.-r-ersi Co s -nowyk.A.jc,-pc <br />CITY/STATE/ZIP CONTRACTOR ADDRESS 4+5-) (-4-) • 0 'CV& cT <br />WATER TABLE DEPTH: <br />ti( PERC TEST # <br />ft GEOGRAPHICAL INFORMATION: Coordinates X <br />BUILDING PERMIT # LAND USE APPLICATION # <br />TYPE OF WORK: NEW INSTALLATION <br />REPLACEMENT <br />0 REPAIR/ADDMON <br />LI OUT-OF-SERVICE SEPTIC SYSTEM <br />0 ENGINEER DESIGNED /ALTERNATIVE <br />El DESTRUCTION <br />0 OTHER <br />NUMBER OF EMPLOYEES: NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: <br />0 COMMERCIAL INSTALLATION WILL SERVE: 0 RESIDENCE <br />ft PROPERTY LINE ft <br />TYPE/MFG CAPACITY gal # OF COMPARTMENTS <br />TYPE/MFG CAPACITY gal # OF COMPARTMENTS <br />DISTANCE TO NEAREST: WELL ft FOUNDATION <br />SIZE TYPE OF PUMP CI PKG TX PLANT CI SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />DATE 1 - 2-0 2-0 <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 />MINIMUM 49 HOUR AD/ICE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209)953-7697 <br />i/c>0.6.4 TITLE P12-0,) • Au- (2- • <br />SEPTIC TANK <br />GREASE TRAP <br />UFT STATION <br />LEACH LINES Ci LEACHING CHAMBERS <br />DISTANCE TO NEAREST WELL <br />FILTER BED WIDTH ft LENGTH <br />DISTANCE TO NEAREST WELL <br />MOUNDED WIDTH ft LENGTH <br />DISTANCE TO NEAREST WELL <br />SUMPS WIDTH ft LENGTH <br />DISTANCE TO NEAREST WELL <br />DISPOSAL PONDS WIDTH ft LENGTH <br />DISTANCE TO NEAREST WELL <br /># OF LINES LENGTH OF LINES ft <br />ft FOUNDATION ft PROPERTY LINE ft <br /> ft DEPTH ft <br />ft FOUNDATION ft PROPERTY LINE ft <br />ft DEPTH ft <br />ft FOUNDATION ft PROPERTY LINE ft <br /> ft DEPTH ft <br />ft FOUNDATION ft PROPERTY LINE ft <br />ft DEPTH ft <br />ft FOUNDATION ft PROPERTY LINE ft <br />SEEPAGE PITS NUMBER WIDTH <br />DISTANCE TO NEAREST WELL ft FOUNDATION <br />ft DEPTH ft <br /> ft PROPERTY LINE ft <br />SIGNED <br />CROSS STREET 1242-1 APN 01.49 - 2-.30 - I 1 PARCEL SIZE I (JE Ac • <br />OWNER ADDRESS 6)0 t E. Lt.-) • CITY/STATE/ZIP L-D L c7 2-44 0 <br />CONTRACTOR e•-• 0 P<Ie- G-E. o C1•3%./ vt4...e,"„)-v Pc-t_ PHONE <br />Lei) C-^ <br />LICENSE El 0C-42 ELJC4S OTHER P(:1 , NUMBER 31S1 EXPIRATION DATE <br />r -•,,-_-=--\ " " <br />Application Accepted By <br />Final Inspection By <br />DEPARTMENT.USE ONLY <br /> Date 7/,//,z C..-) Area /q C1 Employee ID# / <br />Date E SPECIAL PERMIT -Approved by <br />Pit/Sump Soil Character: Character of Soil to Depth of 3 Ft: <br />COMMENTS <br />lli111111111E <br />PAlememr , <br /> RECEiveL <br /> 'IA 24 2020 <br /> DE.„„msNT <br />ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STocicroN CA 95205 -(209) 468-3420 <br />NON-REFUNDABLE PERMIT CALL (209) 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />PE <br />Code <br />SC <br />INFO <br />Received 1/4Checkitl--- Amount <br />Remitted Date Permit/ Invoice # Permit ID# Cash <br />‘1,333 .Cd 3 y,o77- icizzi4f - 4 / .C• -7/2-1)26 <br />ServicM#1 <br />S. 0 c..../ 2A-1 1 :SMCIOV allS 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/14/18