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JOB ADDRESS ; _Tate 7.tz Pe/ crryizip .4-(0,r0 <br />CROSS STREET Z:,"/ j.9 1( /-1) Cei APN 00 -7/1i ILI <br />OWNER NAME Pq“ (/o so PHONE <br />PARCEL SIZE I fl CD <br />OWNER ADDRESS <br />CONTRACTOR 6/17'4 ( tnNyt (c0 <br />CONTRACTOR ADDRESS 3vLgc. Ale pi <br />CITY/STATE/ZIP <br />PHONE 0101 309- 50,?-7 <br />CITY/STATE/ZIP -5101kfal (-4 95.21f <br />LICENSE o K C-42 0 El C-36 OTHER NUMBER 41s7oi15- EXPIRATION DATE 9 - 31-al <br />LIFT STATION SIZE <br /> TYPE OF PUMP <br /> PKG TX PLANT 0 SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />LEACH LINES 0 LEACHING CHAMBERS # OF LINES ( i ) LENGTH OF LINES e.,0 / ft <br />DISTANCE TO NEAREST WELL A90 1 ft FOUNDATION 5-0 i ft PROPERTY LINE r,2(.) ' ft <br />Li FILTER BED WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION 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 ft <br />/14 SEEPAGE PITS NUMBER WIDTH 416 " ft DEPTH 5 ft <br />DISTANCE TO IAREST WELL /5-0 f-- ft FOUNDATION /00 / ft PROPERTY LINE /.0 ' 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 />MINIMUM 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 <br />SIGNED TITLE Z4'1/r--i DATE te /7— <br />1( <br />PAYMENT <br />RECEIVED <br />OCT 1 1 20 21 <br />DE <br />PARTMENT I7E ONLY <br />/2_/4& Area LI/qq Application Accepted By 1:..4 Date it-7/i i i Employee ID# F IZ <br />Final Inspection By 5.7-rs.--", Date 1019 --e.0 2/ 0 SPECIAL PERMIT Approved by <br />Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br />COMMENTS 1:vis4-61) Iii5 It, bi.,1 005- ofiscJimecipd e,I)s-/-»25 frmi-Dotht d lll /in anC 1 pii-s. 1/4)11 <br />i <br />3 1 , e (,,red, f h eAls1-15 OD' let•cil I i lk- one/ a- ..? f p 1 ts. Need 1C1 ' or le4:f.h i/f7es r:rei pi k - ke -r <br />19 toet f 6 IV cooro1))1i,lur" 11,5 2te.s.. <br />I ,...1 <br />PE <br />Code <br />SC <br />INFO <br />Received <br />By <br />Check#/ i2.71.1 Amount <br />Remitted p ate <br />Permit/ <br />Service Request # Invoice # Permit ID# <br />Lid 1 0 I I 41 <br />4 <br /> 3 Do iPi4 (242/ 00 t Li 3?? 9 <br />ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 42-01 <br />4/14/18 <br />SAN JOAQUIN Pn JN TV <br />ENVIRONM N1 Fr EA _Ti- . <br />AL <br />ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JORIQUIN 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: I LIO ,> 0 ft GEOGRAPHICAL INFORMATION: Coordinates X <br />INSTALLATION WILL SERVE: >r- RESIDENCE 0 OTHER <br />ft :SS3114:1UV AlIS E PERC TEST # <br />/51( REPAIR/ADDITION <br />OUT-OF-SERVICE SEPTIC SYSTEM Li DESTRUCTION <br />BUILDING PERMIT # <br /> <br />LAND USE APPLICATION # <br />TYPE OF WORK: <br />NEW INSTALLATION <br />Li <br /> <br />REPLACEMENT <br />Li] ENGINEER DESIGNED /ALTERNATIVE <br />0 COMMERCIAL <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: (3 ) NUMBER OF EMPLOYEES: <br />SEPTIC ANK TYPE/MFG f-fi Sh"), 7/0'1C ree_ CAPACITY gal # OF COMPARTMENTS <br />GREASE.TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS <br />DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE