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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 209 953--7697 FOR INSPECTIONSEXPIRES1 YEM F M D E ISSUED <br />JOB ADDRESS U -y 7 'V'r CITY/ZIP }V-WVt CA <br />CROSS STREET Mq4r. t4rfb.r APN ��� ''v `� 7 PARCEL SIZE ` <br />OWNER <br />PHONE <br />OWNER ADDRESS �� ` CITY/STATE/ZIP <br />CONTRACTOR S 'S 3`C/ .J -f -P 1Gti PHONE t"i,�j�r)AA OLS- p` <br />CONTRACTOR ADDRESS P6 $n,)( &S-0 CITY/STATE/ZIP <br />LICENSE I I C-42 I I C-36 OTHER A NUMBER • EXPIRATION DATE <br />WATER TABLE DEPTH: U py ft GEOGRAPHICAL INFORMATION: <br />J PERC TEST # BUILDING PERMIT # <br />TYPE OF WORK: NEW INSTALLATION R PAIR/ADE <br />X Y <br />D USE APPLICATION # <br />D /ALTERNATIVE <br />REPLACEMENT UUT-UF-SERVICE SEPTIC SYSTEM UESTRU TIO <br />INSTALLATION WILL SERVE: VKESIDENCE IJ COMMERCIAL OTHER <br />NUMBER OF LIVING UNITS: I NUMBER OF BEDROOMS: 0 NUMBER OF EMPLOYEES: <br />P,-"S'EPTIC TANK <br />TYPE/MFG 'p T L_ <br />CAPACITY 1& 5 0 gal <br /># OF COMPARTMENTS Z11 <br />❑ GREASE TRAP <br />TYPE/MFG <br />_ CAPACITY gal <br /># OF COMPARTMENTS <br />ft FOUNDATION 1,0 <br />a <br />DISTANCE TO NEAREST: WELL 106 <br />ft FOUNDATION u I ft <br />PROPERTY LINE 1 ft <br />❑ LIFT STATION <br />SIZE TYPE OF PUMP <br />❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />W -'LEACH LINES <br />LEACHING CHAMBERS <br /># OF LINES <br />I <br />LENGTH OF LINES �� I ft <br />Permit/ <br />Service Request # <br />DISTANCE TO NEAREST <br />WELL 1r�1 <br />ft FOUNDATION 1,0 <br />t <br />ft PROPERTY LINE I O ft <br />❑ FILTER BED <br />WIDTH <br />ft LENGTH <br />ft <br />DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ MOUNDED <br />WIDTH <br />ft LENGTH <br />ft <br />DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />SUMPS <br />WIDTH <br />ft LENGTH �, <br />.t <br />ft <br />DEPTH It.� ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION tO fi <br />ft PROPERTY LINE IC1 ft <br />❑ DISPOSAL PONDS <br />WIDTH <br />ft LENGTH <br />ft <br />DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ SEEPAGE PITS <br />NUMBER <br />WIDTH <br />ft DEPTH w_ PAI <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE <br />I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDAAUGTTN,�AAN <br />JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY RE IRED LIW,{I jj <br />CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COM�v'ryTC AL <br />WORKERS COMPENS IION.LAWS...,.....� �.......,...�..�.....,. -.. �...-...... ,___ <br />HEALTH��ENiq� lY <br />Application Accepted By <br />Final Inspection By A/ <br />Character of Soil to ept <br />COMMENTS GC <br />Area -�;; <br />F1 SPE <br />ump Soil Character: <br />Employee ID# 14%W --D <br />- Approved by <br />PE <br />Code <br />SC <br />INFO <br />Received <br />By <br />41jeck#0 Amount <br />Cash Remitted <br />Date <br />Permit/ <br />Service Request # <br />Invoice # <br />Permit ID# <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />5/5/17 <br />CA <br />