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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAo0;4 COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 <br /> N(KN-REFUNDABLE PERMIT CALL 209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> .a-- <br /> .a c�/� .S z j <br /> JOB ADDRESS :ZZ Zv I CITYRIP G nn <br /> CROSS STREET I� APN �/ Z�� 2C� PARCEL SIZE V' <br /> OWNER NAME O ^' v ` PHONS��S�I ! - Z Z' <br /> OWNER ADDRESS / CITY/STATE/ZIP <br /> CONTRACTOR Se��`�` PHONEC2..Oq � F2 <br /> CONTRACTOR <br /> CONTRACTOR ADDRESS "�,t"J �� CITY/STATE/ZIP't �/�'� <br /> LICENSE C 42 1 C-36 OTHER NUMBER - / EXPIRATION DATE 0 <br /> WATER TABLE DEPTH: 2�0 O ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> [_1 PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION I ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE L I COMMERCIAL L I OTHER <br /> NUMBER OF LIVING UNITS: !� ,/ t IN,U,MBER OF BEDROOMS: 1,'L NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG Oct 71�/l/� 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 C 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 it 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 It LENGTH ft DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ® SEEPAGE PITS NUMBER WIDTH J- It DEPTH Z ft <br /> DISTANCE TO NEAREST WELL FOUNDATION /O ft PROPERTY LINE ` ft <br /> a <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 COMPENSATION LAWS. <br /> MINIMUM 48 WUR ADVANCE NOTICE REQUIRED FOR INSPECCT'ION`S-PLEASE CALL 209 953-7697 <br /> E <br /> SIGNED TITLS_ ,"i �7�� DATE <br /> F. <br /> JTR NAL <br /> D P RI VENT <br /> —I—I— 17 <br /> ARTMEN US O LY <br /> Application Accepted By Date p �Arlyaa Employee ID# <br /> Final Inspection By Date ' I Y SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 4 Ft:� Pit/Sump Soil Character: <br /> COMMENTS `w�"�� !iU•C/ (4J �l rP�Z� Z <br /> PE SC Received Check#/ Amount Permit/Code INFO B a emitted Date Service Request# Invoice# Permit ID# <br /> o <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 5/5/17 <br />