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JOB ADDRESS <br />CROSS STREET <br />OWNER NAME <br />l241 C • St. ter- <br />rtkuq. <br />At, ae,./1.7r /2-4 C• <br />Cittaip LOC-le-Efbe- I) 9 S-2- 31 <br />APN 0S-1 - Cb 5-(1, PARCEL SIZE 2-2 Ac • <br />PHONE 73 0) 3d - <br />orasTATEizip <br />CONTRACTOR (AV Ov6c4 6-E0 &11 /4/1)1•420-nk PHONE 3 (61" 3-1 <br />CONTRACTOR ADDRESS 1407 GO • OAK. T. . <br />WATER TABLE DEPTH: <br />PERC TEST # <br />ft GEOGRAPHICAL INFORMATION: Coordinates X <br />BUILDING PERMIT # LAND USE APPLICATION # <br />TYPE OF WORK: NEW INSTALLATION . <br />REPLACEMENT <br />REPAIR/ADDITION <br />OUT-OF-SERVICE SEPTIC SYSTEM <br />ENGINEER DESIGNED /ALTERNATIVE <br />DESTRUCTION <br /> <br />INSTALLATION WILL SERVE: _ RESIDENCE COMMERCIAL <br /> <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: <br />L.. OTHER <br />NUMBER OF EMPLOYEES: <br />0 <br />0 <br />SEPTIC TANK <br />GREASE TRAP <br />TYPE/MFG CAPACITY gal # OF COMPARTMENTS <br />TYPE/MFG CAPACITY gal # OF COMPARTMENTS <br />DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br />0 LIFT STATION SIZE TYPE OF PUMP PKG TX PLANT 0 SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />0 LEACH LINES 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 />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 />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,IjpUR AD /CE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL 1209) 953-7697 <br />SIGNED TITLE I' - Cr i2- • DATE I r- 2 <br />OWNER ADDRESS 1432. 57"N-115 (. Au S Jr. CITY/STATE/ZIP Lob I C.,'\ S-2.40 <br />LICENSE C-42 LII C-36 OTHER C 6 Cr NUMBER 2- ( EXPIRATION DATE '4 3.0 <br />trtA) <br />4,14, :SSMIOCIV 3.1.1S 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 />Application Accepted B <br />Final Inspection By <br />Character of Soil to D <br />COMMENTS 6 <br />DEPARTMENT USE pNL Y <br />Date /Area Li Employee ID# <br />Date 4/I 11/20-24 SPECIAL PERMIT -Approved by <br />of 3 Ft: Pi ump Soil Characte : <br />0,-/1ol/V" t/1"-te Qq fl 1,..; <br />141 <br />D A <br />r1D-e€10 pe,v-c- <br />PE <br />Code <br />SC Received <br />INFO —Cash <br />Clies,a#e Amount <br />Remitted Date Permit/ <br />i emett # Invoice # Permit ID# <br />I-Pd .R3 a16-___ 17.R f 1 5111124 ,rtr -r-1-1 <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4/14/18