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JOB ADDRESS 9 06.6u ZIA, 1/ hIei CITY/ZIP "1--c /4' J\--1 <br />LAND USE APPLICATION # BUILDING PERMIT # E PERC TEST # <br />SIGNED <br />M1NIu UM 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209)953-7697 <br />TITLE —7 .)--;44 /Tv DATE <br />TYPE OF WORK: 11 NEW INSTALLATION <br />LI REPLACEMENT <br />1_1 REPAIR/ADDITION <br />1_1 OUT-OF-SERVICE SEPTIC SYSTEM <br />1 1 ENGINEER DESIGNED /1.,TERNATIVE <br />DESTRUCTION n <br />INSTALLATION WILL SERVE: E RESIDENCE <br />NUMBER OF LIVING UNITS: <br />E COMMERCIAL <br />NUMBER OF BEDROOMS: <br />E OTHER <br />NUMBER OF EMPLOYEES: <br />U <br />0 <br />U <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 ft <br />LIFT STATION SIZE TYPE OF PUMP PKG TX PLANT CI SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />LEACH LINES LJ LEACHING CHAMBERS # OF LINES LENGTH OF LINES ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />0 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 />0 SUMPS WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />0 DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br />0 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 />WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X <br />CROSS STREET /0 / I APN / 7s c C ,;z PARCEL SIZE 1. a 1 <br />OWNER NAME /OVA'S C/711177 <br />OWNER ADDRESS 167 I ()keg /411 CITY/STATE/ZIP lO e. 6 <br />CONTRACTOR —101-1-\(t.- IA ) A )-H1 A I PHONE / ,,,zO 9). s 7 i 1 1 3;/- <br />CONTRACTOR ADDRESS CITY/STATE/ZIP tf-)rifp&K+0/1 , 0/4 9O72W <br />LICENSE E LC-42 E Li C-36 OTHER NUMBER EXPIRATION DATE <br />PHONE <br />(eg <br />Application Accepted B <br />Final Inspection By t <br />DEPARTMENT USE ONLY <br />Area yq q Employee ID# All, Date c3/4? ,61? / <br /> ----- Date ii 714 ZZ.. 0 SPECIAL PERMIT -Approved by <br />Character of Soil to Depth of 3 Ft: it/Sump Soil Character: <br />COMMENTS rionneCi4115 -it> Cry SelAier <br />671') <br />A <br />SA <br />1 <br />d JOAQUIN COUNTY <br />=NVIRDNMENTAL <br />L—H DEPARTMENT <br />PAYMENT <br />RECEIVE <br />JUN 21 202 <br />PE <br />Code <br />SC <br />INFO <br />Received Check#/ <br />4#1•1 Remitted <br />Amount Permit/ ft Service Request # Invoice # Permit ID# <br />i-pal 0 7S" / <br />ielV <br />I, i Lt 't iS-02 (.011.1 iCT—OOSN(610 <br />ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 42-01 <br />4/14/18 :SS32IUUNv' HilS 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