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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 9.53-7697 FOR INSPECTIONS EXPIRE <br /> ^sS <br /> �11 YEAR FROM DATE ISSUED <br /> JOB ADDRESS $/ I7 • 04o, CITY/ZIP ► Q5o"��0 -" <br /> II <br /> CROSS STREET U �"^-- '� APN � Q � PARCEL SIZE ' <br /> - <br /> ` 7 ,+ <br /> 0,7—4 o <br /> 30-/5� <br /> OWNER NAME I'+AA(-+\a- 06_(_rV�y t'i PHONE d ! f �r <br /> { l f �J i � ,� �{ �}�r� r <br /> OWNER ADDRESS 1357 . v�� l 1j• CITY/STATE/ZIP CL,,), LA {�XJg0 <br /> CONTRACTOR_ At2I fA�f/�-�y® f C9+h �s.0 Id/ti PHONE 1 ��`3,37 _ '8a [' <br /> CONTRACTOR ADDRESS `�6 cocer 'Dr. �(�q CITY/STATE/ZIP �k,,4 S-pr+,wts . CA q6.150 <br /> LICENSE Ll C-42 F1 IC-36 OTHER — NUMBER gJ-3q� EXPIRATION DATE-3A31/17 <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ! PERC TEST # BUILDING PERMIT# 13 7)72—f_F LAND USE APPLICATION# <br /> TYPE OF WORK: C REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE <br /> 1 REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: "-RESIDENCE f COMMERCIAL 11 OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> 14. SEPTIC TANK TYPEIMFG I � CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL it FOUNDATION it PROPERTY LINE it <br /> ❑ LIFT STATION SIZE TYPE OF PUMP__. ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES 1 LEACHING CHAMBERS #OF LINES T LENGTH OF LINES h it <br /> DISTANCE TO NEAREST WELL ted ft FOUNDATION ft <br /> PROPERTY ft <br /> ❑ FILTER BED WIDTH it LENGTH ft DEPTH it <br /> DISTANCE TO NEAREST WELL ft FOUNDATION it PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH it LENGTH ft DEPTH it <br /> DISTANCE TO NEAREST WELL it FOUNDATION ft PROPERTY LINE it <br /> ❑ SUMPS WIDTH ft LENGTH _ft DEPTH it <br /> DISTANCE TO NEAREST WELL it FOUNDATION it PROPERTY LINE it <br /> Q DISPOSAL PONDS WIDTH it LENGTH It DEPTH it <br /> DISTANCE TO NEAREST WELL itFOVNDA kON�y K PROPERTY LINE it <br /> SEEPAGE PITS NUMBER 2 WIDTH �� i�'fa ft DEPTH z_S- it <br /> DISTANCE TO NEAREST WELL 7 it FOUNDATION it PROPERTY LINE it <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 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 203 953-7697 <br /> SIGNED I ! T+ITI II IP• •+ %I DATE <br /> MIN 5' <br /> I 4c <br /> J! <br /> I I <br /> I li4 <br /> 14� <br /> P <br /> 4 ' <br /> I <br /> { I a <br /> S <br /> I I jkl UIN COIKry <br /> T 1 V r <br /> I <br /> rt <br /> Application Accepted By [late Area –�� Employee ID#��`—`� <br /> Final Inspection By Date ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: A Pit/Sump Soil Character: <br /> COMMENTS <br /> S S l Nft cti51t6 tv.41VC Se S &W IV <br /> PESC Received heck Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO B ash Remitted Service Re uest# <br /> / L6 4108'3 ;157 "' "1 1-11 <br /> 42.01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4124112 <br />