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42-01 <br />4/14/18 AL(6.2244'?8' <br />ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />14 <br />it <br />ii-4‘)Pt" <br />ft FOUNDATION ft PROPERTY LINE ft DISTANCE TO NEAREST WELL <br />LICENSE iC-42 C C-36 OTHER " A" NUMBER 1068208 EXPIRATION DATE 8-31-22 <br />/ 5-7 /7 Gcter-t2y <br />r t-c I <br />(r r-,7 F4.061 <br />Car/Zip 1.49 <br />APN C Pd300 PARCEL SIZE q/ 7? <br />PHorie,5517 • L 38 -/flf <br />CITY/STATE/ZIP <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: 3 -1L3C--) It GEOGRAPHICAL INFORMATION: Coordinates X <br />BUILDING PERMIT # PERC TEST # <br />DISTANCE TO NEAREST WELL ft FOUNDATION <br />WIDTH ft LENGTH <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE <br />LEACHING CHAMBERS # OF LINE. LENGTH OF LINES <br /> ft PROPERTY LINE <br />ft DEPTH <br />SIZE TYPE OF PUMP PKG TX PLANT 0 SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />WIDTH ft LENGTH ft DEPTH <br />DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION <br />WIDTH ft LENGTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION <br />WIDTH ft LENGTH <br /> ft PROPE.TY I iNE <br />ft DEPTH ft <br />ft <br />ft <br />ft <br />ft <br />ft <br />ft <br /> <br />ft <br />ft <br />ft <br />ft PROPERTY LINE <br />DEPTH <br /> ft PROPERTY LINE <br />ft DEPTH <br />LIFT STATION <br />LEACH LINES <br />FILTER BED <br />CI MOUNDED <br />SUMPS <br />DISPOSAL PONDS <br />SEEPAGE PITS <br />TYPE OF WORK: NEW INSTALLATION, <br />X REPLACEMENT / <br />SEPTIC TANK <br />GREASE TRAP <br />TYPE/MFG <br />TYPE/MFG <br />DISTANCE TO NEAREST WELL ft FOUNDATION <br />NUMBER WIDTH <br />LAND USE APPLICATION # <br />ENGINEER DESIGNED <br />A <br />/ITERNATIVE <br />DESTRUCTION )6 ji <br />REPAIR/ADDITION <br />OUT-OF-SERVICE SEPTIC SYSTEM <br />gal # OF COMPARTMENTS <br />CAPACITY gal # OF COMPARTMENTS <br />L CAPACITY 17-00 <br /> <br />INSTALLATION WILL SERVE: Ai RESIDENCE <br /> <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: <br />I COMMERCIAL _I OTHER <br />NUMBER OF EMPLOYEES: <br />JOB ADDRESS <br />CROSS STREET <br />OWNER NAME <br />OWNER ADDRESS <br />CONTRACTOR Sepit s e.42. v ce-s. ‘00-4440 PHONE ci`16 - 6 <br />CONTRACTOR ADDRESS Po 60 56ct CITY/STATE/ZIP 101 146W CA. 7.56? <br />. . . . - <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 MIR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209)953-7697 <br /> TITLE DATE SIGNED :SS-3210(1V 311S Application Accepted By <br />Final Inspection By <br />Character of Soil to Depth o Ft: <br />COMMENTS Ulcie -fermi I reA er <br />F <br /> <br />Sump Soil Character: <br /> <br />11 /IC reiD/4!i. e41e ii (r rneifl <br />"zi a 1, -174 <br />DEPARTMENT US,I20NLY <br /> Date Area Vt.? CI Employee ID# <br />Date 412t-71 [ I SPECIAL PERMIT Approved by <br />PE <br />Code <br />SC <br />INFO <br />Received <br />., A <br />Check#4 <br />Cas11 . <br />Amount <br />Remitted <br />Permit/ <br />SArvic ice Request # <br />I.LiGt 1 <br />Invoice # Permit ID# <br />11 ) 0 q 1 I S- 10 eRiatiff 45 3D0 Fill