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INSTALLATION WILL SERVE: <br />NUMBER OF LIVING UNITS: <br />241 -g <br />APN <br />CITY/STATE/ZIP <br />LAND USE APPLICATION # BUILDING PERMIT # <br />NUMBER OF BEDROOMS: <br />U COMMERCIAL RESIDENCE OTHER <br />NUMBER OF EMPLOYEES: <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br />CALLj2Z953-7697 FOR NON-REFUNDABLE PERMIT <br />304 E WEBER AVE - FL - SToctcTott CA 95702 - (209)468-3420 <br />INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />JOB ADDRESS <br />CROSS STREET <br />OWNER NAME <br />OWNER ADDRESS <br />CONTRACTOR <br />ft GEOGRAPHICAL INFORMATION: Coordinates X <br /> <br />NEW INSTALLATION U REPAIR/ADDITION <br /> <br />A REPLACEMENT 0 ."34•CI DESTRUCTION <br />5.C., <br />/ LENGTH OF LINES -•-0...- ft <br />FOUNDATION ft PROPERTY LINE ft <br />ft FOUNDATION ft Pr, 1-'• sykiftla <br />DEPT \.11 ft <br />ft <br /> ft <br />ft LENGTH ft ROTH ft <br />WELL ft FOUNDATION fl <br />ft LENGTH i ' <br />iorir/i) AO II <br />WELL ft FOUNDATION ft jeitp#SOOD? a ft <br />f5 ft <br />501 m \BOW -ctitelsTr ft LENGTH ft uEPIYIW. DEPAB' ft <br />u"L114 WELL ft FOUNDATION ft , .- PROPERTY LINE ft <br />ft DEPTH X-- ft <br />il PROPERTY LINE ft <br />I HEREBY CERTIFY T I HAVE PREPARED THIS APPLICATION AND THE WORK WILL REDONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br />ORDINANCES, WS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br />LEACH LINES 0 LEACHING CHAMBERS # OF LINES <br />DISTANCE TO NEAREST WELL ifiC4-A L 1 4- ft <br />FILTER BED BED Wirrni ft LENGTH <br />DISTANCE TO NEAREST WELL <br />MOUNDED WIDTH <br />DISTANCE TO NEAREST <br />SUMPS WIDTH <br />DISTANCE TO NEAREST <br />DISPOSAL PONDS WIDTH <br />DISTANCE TO NEAREST <br />SIGNED <br />E REQJ It ED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 <br />I t/1 r. • TV <br />i1 #LA-) <br />/,-(.64 SE .0 <br />C <br />Date __f_[_o)-2(1-,_,=-7 _ Area Employee ID# t.52((1f <br />Date ....4j ;7;4Z-. U SPECIAL PERMIT - Approved by <br /> Pit/Sump Soil Character: <br />C 0A) <br />I •,- <br />"--• 0 /-Fr. 147- 01,1 Da's, <br />Application Accepted <br />Final Inspection By <br />Character of Soil to Dep o13 Ft: <br />PE <br />Code <br />Si <br />INFO <br />Received <br />By <br />Amount <br />fiemitted Date Permit/ ' <br />Service Request # 1/ voice # } Permit ID# <br />Cash <br />4 2-'O (is Li:41_6k _ lief 2// 112 -- leo - l''‘) 0/45 15RDRO a I 0 GI F- <br />42-02-00 1 bl-le—e-e) „4 e7eye xc-roaa-AvagKeamet,(40 A <br />12 '2212003 4 fe-,,i,,errx ,56,110 .27r/S7,41-4-147 A47/Gtcriette-c-, 36s4 '.E24,LiciiicraKe(eas-af <br />C6101~7if te-ase-,71b ilerneae0 -1/m* ---V4071,4"/ 1,4u, Nos...30 'so) <br />Si\a4A:v‘o-- 9-kv\-Crivce <br />V•4- AC C3h <br />ENGINEER DESIGNED /ALTERNATIVE TYPE OF WORK: <br />V <br />2.7cm <br />ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />PARCEL SIZE CA 2-3 c.,C6 - <br />PHONE <br />\c-k_ CITY/Zip <br />WATER TABLE DEPTH: <br />PERC TEST # <br />SEEPAGE PITS NUMBER WIDTH <br />DISTANCE TO NEAREST WELL ftEQUNDATION <br />C4r,„ <br />Aar _ <br />COMMENTS be_ a io7—e.; F <br />PHONE a° - 9 t <br />TYPE/MEG <br />TYPE/MEG <br />DISTANCE TO NEAREST: WELL <br />TYPE OF PUMP SIZE <br />CAPACITY /Zoo gal S OF COMPARTMENTS <br /> CAPACITY gal gal ft OF COMPARTMENTS <br />ft FOUNDATION ft PROPERTY LINE ft <br />SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />SEPTIC TANK <br />GREASE TRAP <br />PKG TX PLANT <br />LIFT STATION <br />/ <br />CONTRACTOR ADDRESS <br /> CITY/STATE/Zip <br />LICENSE 1:1 C-42 0 C-36 OTHER NUMBER EXPIRATION DATE