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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 INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED <br /> JOB ADDRESS C CITY/ZIP <br /> CROSS STREET V APN OO:`, /v L / PARCEL SIZE <br /> 0 <br /> c <br /> OWNER NAME Aedian DeEtt PHONE �r <br /> OWNER ADDRESS `<, [J�Jl+W CITY/STATE/ZIP <br /> yy <br /> CONTRACTOR J V SRA}}�� ,C PHONE ///^���� <br /> CONTRACTOR ADDRESS c93/ e Sero b,, CITY/STATE/ZIP / 64 <br /> LICENSE 11X-42 ❑l IC-36 OTHER NUMBER G� EXPIRATION DATE �/ -1,9 <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATIO : Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# R AND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION _ AIR/ADDITION I ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT I OUT-OF-SERVICE SEPTIC SYSTEM I j DESTRUCTION <br /> INSTALLATION WILL SERVE: ^^ RESIDENCE I COMMERCIALFI OTHER <br /> NUMBER OF LIVING UNITS: d NUMBER OF BEDROOMS: a NUMBER OF EMPLOYEES: <br /> SEPTIC TANK TYPE/MFG L CAPACITY ldW gal #OF COMPARTMENTS J <br /> GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL j ft FOUNDATION ft PROPERTY LINE 00ft <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 'J�J ft <br /> DISTANCE TO NEAREST WELL /-50 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 It LENGTH ft DEPTH �^ <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE i _` e <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH Cr _ <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH F q� <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINET/,/y'4:44 _ <br /> SEEPAGE PITS NUMBER WIDTHS !' ft DEPTH ft <br /> DISTANCE TO NEAREST WELL D' ft FOUNDATION o S(�,ft PROPERTY LINE [� Tft <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 HOUR ADVANCE NOXICE REQUIRED FOR INSPECTIONS -PLEASE CALL 209 953-7697 <br /> SIGNED TITLE LQ DATE <br /> 01 <br /> S <br /> c ,f <br /> 1IVI ! <br /> 156— 1 <br /> EPARTME T SE N Y <br /> Application Accepted By Date- Area Employee ID# <br /> Final Inspection By Date 10,/(�11 TC ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to DeptK/—Of 3' t: Pit/Sump Soil Character: <br /> COMMENTS <br /> PE SC Received eck#/ Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO By Cas Reryktteo Service Request# <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />