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TYPE OF WORK: INSTALLATION <br />REPLACEMENT <br />REPAIR/ADDITION <br />OUT-OF-SERVICE SEPTIC SYSTEM <br />ENGINEER DESIGNED /ALTERNATIVE <br />0 DESTRUCTION <br /> <br />INSTALLATION WILL SERVE: SIDENCE 0 COMMERCIAL <br /> <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS:-3 <br />0 OTHER <br />NUMBER OF EMPLOYEES: <br />0<EPTIC TANK TYPE/MFG fL CAPACITY 1 Li a gal # OF COMPARTMENTS el. <br />0 GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS <br />DISTANCE TO NEAREST: WELL i 50 ft FOUNDATION ft PROPERTY LINE ,911- ft <br />LIFT STATION SIZE TYPE OF PUMP U PKG TX PLANT U SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />_... -•,..."-- <br />LEACH LINES LEACHING CHAMBERS # OF LINES LENGTH OF LINEs ft <br />DISTANCE TO NEAREST WELL ft ,FOUNDATION ft PROPERTY LINE ft <br />FILTER BED WIDTH ?•01 ft LENGTH 1 ' A )1.0 ft DEPTH 1 4 ft <br />DISTANCE TO NEAREST WELL I Or) ; ft FOUNDATION 0 I ft PROPERTY LINE .51* ft <br />0 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 />JOB ADDRESS 234 ct c (di <br />CROSS STREET 12 1,3 r) <br />OWNER NAME O yvi 1 )}i <br />CITY/ZIP i'Vleid-ovn C: 4 <br />APN -,/1 0 iI PARCEL SIZE <br />PHONE <br />LICENSE C-42 LI DC-36 OTHER EXPIRATION DATE c-c5-4 NUMBER <br />t CONTRACTOR <br />CONTRACTOR ADDRESS 193 18,7);i: <br />BUILDING PERMIT # 00 3.c,L: 07 LAND USE APPLICATION # PERC TEST # <br />WATER TABLE DEPTH: )1101 10 ft GEOGRAPHICAL INFORMATION: Coordinates X <br />CITY/STATE/ZIP <br />PHONE <br /> CITY/STATE/ZIP ;•(1e 1-a,+ 7 5 <br />OWNER ADDRESS <br />- <br />Application Accepted B <br />Final Inspection By Date -3A 51/0 I 1J SPECIAL PERMIT - Approved by <br />Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br />COMMENTS oft4e1t/rj <br />DEPARTMENT USE ONLY <br />Date SP-I Area -/elef Employee ID# <br />her „fells 0-11) <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 <br /> CALL (209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <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 e--0571 DATE-3 4-i :SS321ClUy 311S 644, <br />PE <br />Code <br />SC <br />INFO <br />Received qectita Amount <br />Remitted Date Permit/ <br />Service Request # Invoice # Permit ID# Cash <br />.--la I 1 I I 7 9-- 72 ly --753 ,s--?Li S`R ON 33u2 \ <br />ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 42-01 <br />4/14/18