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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT P'/'4 <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 <br />I14UN-1'St-UNUABLE rLHiMII (;ALL (ZU9) 953-76/97 FOR INSPECTIONS <br />JOB ADDRESS I � / LC7.3 Aj 0-60 — <br />CITY/ZIP-CROSS STREET m""" ��i.ti^/// —�EI� APN <br />`OWNER NAME <br />'OWNER ADDRESS <br />U <br />EXPIRES 1 YEAR FROM DATE ISSUED <br />PARCEL SIZE -;A1, yy <br />�j <br />LQ 4 c.!< 5=e r S <br />� CONTRACTOR �I�-[, 4 �-L PHONE � � e'V_�� <br />CONTRACTOR ADDRESS�G �o CITY/STATE/ZIP®rNr off' C�S <br />LICENSE 1 I C-42 I I C-36 OTHER NUMBER EXPIRATION DATE1� <br />WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: <br />1 PERC TEST # BUILDING PERMIT # - <br />TYPE OF WORK: NEW INSTALLATION REPAIR/ADC <br />Coordinates X Y <br />LAND USE APPLICATION #_ <br />IN ENGINEER DESK <br />REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION <br />NED/ALTERNATIVE <br />INSTALLATION WILL SERVE: - SIDENCE !J COMMERCIAL IJ OTHER <br />NUMBER OF LIVING UNITS: {✓/ NUMBER OF BEDROOMS: _ ! NUMBER OF EMPLOYEES: <br />❑ SEPTIC TANK <br />❑ GREASE TRAP <br />❑ LIFT STATION <br />TYPE/MFG <br />TYPE/MFG <br />DISTANCE TO NEAREST: WELL <br />SIZE TYPE OF PUMP <br />LEACH LINES LEACHING CHAMBERS <br />DISTANCE TO NEAREST WELL I Y 0 i� ft <br />❑ FILTER BED WIDTH ft LENGTH <br />CAPACITY <br />CAPACITY <br />It FOUNDATION <br />❑ PKG TX PLANT <br />gal # OF COMPARTMENTS <br />gal # OF COMPARTMENTS <br />ft PROPERTY LINE ft <br />❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br /># OF LINES 4_ LENGTH OF LINES 530 / ft <br />FOUNDATION I dG f ft PROPERTY LINE fJ , ft <br />ft DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft <br />FOUNDATION <br />It PROPERTY LINE <br />ft <br />Permit/ <br />Service Request # <br />Invoice # <br />Permit ID# <br />1 <br />_ <br />MOUNDED WIDTH <br />ft LENGTH <br />) 072 9 41 <br />It DEPTH <br />/Q�1.�.eft_ <br />DISTANCE TO NEAREST <br />WELL <br />It <br />FOUNDATION <br />ft PROPERTY LINE <br />SUMPS WIDTH <br />It LENGTH <br />ft DEPTH <br />DISTANCE TO NEAREST <br />WELL <br />ft <br />FOUNDATION <br />ft PROPERTY LINEA <br />- <br />Pp ft <br />DISPOSAL PONDS WIDTH <br />ft LENGTH <br />ft DEPTH <br />j <br />018 <br />DISTANCE TO NEAREST <br />WELL <br />ft <br />FOUNDATION <br />ft PROPERTY LINE <br />O`gQI/I <br />SEEPAGE PITS NUMBER <br />WIDTH <br />ft DEPTH <br />""LT NMFNT ft <br />DISTANCE TO NEAREST <br />WELL <br />ft <br />FOUNDATION <br />ft PROPERTY LINE <br />TMEAIT <br />I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN <br />JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br />CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br />WORKERS COMPENSON LAWS. <br />MINIMUMOUIR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL 209 953-7697 <br />SIGNED TITLE On �-z DATE L% -y C <br />Application Accepted Bf� <br />Final Inspection By <br />Character of Soil to Depth of 3 Ft: <br />COMMENTS -7/z1 _ZI <br />• EPARTMENT S N Y <br />Date • Area Employee ID# <br />Abqrip <br />Date 4 ❑ SPE AL PERMIT - Approved by <br />Pit/Sump Soil Character: <br />PE <br />Code <br />SC <br />INFO <br />Received <br />B <br />hec <br />sh <br />Amount <br />Remitted <br />Date <br />Permit/ <br />Service Request # <br />Invoice # <br />Permit ID# <br />1 <br />I <br />) 072 9 41 <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />5/5/17 <br />