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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 1 YEAR <br /> —FROM DATE ISSUED <br /> JOB ADDRESS 3 qO C. O CITY/ZIP MP C <br /> CROSS STREET • ` <br /> {': Q I"jjr0ld APN O)3P-40 S�Ij� PARCEL SIZE ( tyl <br /> 0 <br /> 0 <br /> OWNER NAME PHONE <br /> m <br /> OWNER ADDRESS / CITY/STATE/ZIP <br /> C(// <br /> CONTRACTOR 6414- P ((�� be, <br /> ���6 PHONE do g-//3Cc9 <br /> CONTRACTOR ADDRESS ;)31jlo•o be,- CITY/STATE/ZIP �/0d, <br /> LICENSE ❑KE 42 G..i C-36 OTHER NUMBER�,5 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 �i ENGINEER DESIGNED/JgLTERN TIV/E �' <br /> REPLACEMENT rl OUT-OF-SERVICE SEPTIC SYSTEM X DESTRUCTION .InN /L/y <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: ^ NUMBER OF EMPLOYEES: <br /> / <br /> SEPTIC TANK TYPE/MFG C G C��/FC P1 CAPACITY 1000 gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL So ft FOUNDATION S ' ft PROPERTY LINE '67 <br /> , ft <br /> ❑ LIFTSTATION SIZE TYPE OF PUMP ❑ PKGTX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES ii LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY L�INNE� ft <br /> �! <br /> 131 FILTER BED WIDTH ' ft LENGTH L417 I DEPTHDow i ft <br /> / DISTANCE- -AREST WELL SO f fl INDATION ID It PP—.—I INF ft <br /> ❑ MOUNDED WIDTH ft LENGTH_ A ft DEPTH <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 It 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 It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <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 NO CE REQUIRED FOR I SPE TI N -PLEASE CALL 209 953-7697 <br /> SIGNED TITLE C04A*4A1 DATE 07—/.S-/ <br /> AYMENT <br /> Q cANTY ECEIVE� <br /> `I A T I Man,AITI <br /> EB 15 2019 <br /> JOAQUIN COUNTY <br /> 71 -ENVIRONMENTAL <br /> LTH DEPARTMENT <br /> DEPARTMENT U E ONLYb <br /> Application Accepted By Date 7 Area <br /> Employee ID# 7KC <br /> Final Inspection By Data 2 LK SPECIAL PERMIT-Approved by e <br /> Character of Soil to Depth of 3 Ft: A Pit/Su S iI Charact <br /> COMMENTS SP� 1 (1' /Ol �C07ISLi s� <br /> PE SC Received Check Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO Bv ash f. Remitted Service Re uest# <br /> i Soo <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />