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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT P -- ' <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 SUED <br /> JOB ADDRESS YS `e(47 ,f A V e, _nCITYRY10�, <br /> IP n s <br /> CROSS STREETA614 Cc�YI /� ,S Gdi A P N 1 � V�Iy PARCEL SIZE <br /> OWNER NAME u� S /N� /`'C-�1 �� __ PHONE <br /> OWNER ADDRESS �S / L � ✓� CITY/STATE/ZIP <br /> CONTRACTO PHONE <br /> CONTRACTOR ADDRESS CITY/STATE/ZIP <br /> LICENSE 1 I C-42 I I C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNA <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION ' <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL J-1 OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH _ ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ 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 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 COMPEN�ION LAWS. <br /> MUM40 HOUR <br /> AD CE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953:Z697/ <br /> SI D TITLEDATE ql7tr <br /> ENT <br /> VED <br /> ?018 <br /> UN OUN <br /> N <br /> MF/yT <br /> PARTMEN SEONL <br /> Application Accepted B Date Area Employee ID# <br /> Final Inspection By Date `� �l _ ❑ SPECIAL PERMIT Approved by <br /> Character of Soil to D pth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS � <br /> , -G DKK P <br /> PE SC Received Chec Amount Permit/Code INFO ash emitted ate Service Request# Invoice# Permit ID# <br /> ?lL s e <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 5/5/17 <br />