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CITY/ZIP bl(±PAA) - ce.? <br />oriS-OdS PARCEL SIZE , 3q <br />PHONE :SSSZiatIV &LIS PERC TEST # BUILDING PERMIT # <br /> <br />LAND USE APPLICATION # <br />ft DEPTH <br />ft PROPERTY LINE <br />ft DEPTH 9)/ ) <br />ft PROPERTY LINE )g <br />ft DEPTH <br />0 1 <br />ED RECEIV <br />2020 2 SIP 1 5 <br />SAN JOAOUM <br />ENV1RONN <br />COUN <br />< <br />Zr) <br />ENTAL 0 <br />HEALTH DEPARIMENT <br />hi <br />I0 c <br />DEPARTMENT USE ONLY <br /> Date 91/s-A i:)0 Area g I qg Emplo7ele ID# b 4 <br />Dates / 1 iviSm3 A SPECIAL PERMIT - Approved by Cie <br />Pit/Sump Soil Character: <br />tyi5i-k5 5)01' -1-efrn o n ex i s I- i'lj lot. 5 (Amp W INS .R. Fl. <br />Application Accepted <br />Final Inspection By <br />Character of Soil to Depth of 3 F. <br />COMMENTS F4i11115 sesfem. <br />./Y <br />1z -(+ .cc-t :f c-t 6-Pfra--7 <br />bor . wtil. -e-' i 4 ktecr5 S ; /O d(44._ <br />ONSYTE INAS EWATER TREATMENT SYSTEM PERM11T <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAzEL.ToN AVENUE - STocKToN CA 95205 - (209) 468-3420 <br />NON-REFUNDABLE PERMIT CALL (209) 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />JOB ADDRESS <br /> <br />V9C <br />CROSS STREET /4/...1/ /2k/1,4-- APN <br />OWNER NAME r is+6,.., <br />OWNER ADDRESS CITY/STATE/ZIP <br />CONTRACTOR M.t., /V4Afir ).44f i '4 7. <br />PHONE q..7/ c?i/ <br />CONTRACTOR ADDRESS /09 l'41}9 <br />CITY/STATE/ZIP --5.7.744.44.-1 049_5-2) <br />LICENSE 0 LIC-42 OLIC-36 OTHER fet <br /> <br />NUMBER C,,'EXPIRATION DATE / I 0 <br />WATER TABLE DEPTH: ft <br /> <br />GEOGRAPHICAL INFORMATION: Coordinates X <br />TYPE OF WORK: O NEW INSTALLATION <br />0 REPLACEMENT <br />j›< REPAIR/ADDITION <br />(-1 OUT-OF-SERVICE SEPTIC SYSTEM <br />0 ENGINEER DESIGNED /ALTERNATIVE <br />0 DESTRUCTION <br /> <br />INSTALLATION WILL SERVE: ,R RESIDENCE <br /> <br />1: COMMERCIAL <br /> 0 OTHER <br /> <br />NUMBER OF LIVING UNITS: <br />NUMBER OF BEDROOMS: (9. NUMBER OF EMPLOYEES: <br />[a SEPTIC TANK TYPE/MFG CAPACITY gal # OF COMPARTMENTS <br />Ul GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS <br />DISTANCE To NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br />Eil LIFT STATION SIZE TYPE OF PUMP <br /> <br />UI PKG TX PLANT ID SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />LEACH LINES <br />la FILTER BED <br />la MOUNDED <br />k SUMPS <br />LEACHING CHAMBERS # OF LINES i LENGTH OF LINES ,?) <br />WELL _ -57) j ft FOUNDATION } /2 ' ft PROPERTY LINE <br />ft LENGTH ft DEPTH <br />WELL ft FOUNDATION ft PROPERTY LINE <br />ft LENGTH <br />DISTANCE TO NEAREST <br />WIDTH <br />DISTANCE TO NEAREST <br />WIDTH <br />DISTANCE TO NEAREST WELL ft FOUNDATION <br />WIDTH 0 ft LENGTH <br />DISTANCE TO NEAREST WELL <br /> <br />ft FOUNDATION <br />UI DISPOSAL PONDS WIDTH ft LENGTH <br />ft <br />ft <br />ft <br />ft <br />ft <br />ft <br />ft <br />ft <br />ft <br />ft <br />ft <br />ft <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE <br />UI SEEPAGE PITS NUMBER WIDTH ft DEPTH <br />DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE <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 />, MI UM 48 HO NCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 <br /> TITLE Afi 0 pAymENTATE .--/-1 2 z2 <br />30° <br />11E <br />Code <br />SC <br />INFO <br />Received <br />Y <br />Check#/ Amount <br />Remitted ate / <br />i Permit/ <br />Service Request # Invoice # Permit ID# <br />41;1`) HS" 't3 z) 6e)-57kv M-#0200 <br />., • <br />42-01 -Ei .e>.(4 s -11 /:,011,21 - ,-- wry- <br />ONSITE WASTEWATER TRTMNT STSTEM PERMIT <br />eto ;F-kviv? 04-s4e (D; ;ow) <br />4/14/18