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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 09 953-7697 FOR INSPECTIONS c EX/PIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS CITY/ZIP 9 <br /> CROSS STREET 4,1i, %/ X APNaK— PARCEL SIZE <br /> }� <br /> OWNER NAME /��i� rCC7 --C� }j /7 G G 1 PHONE N <br /> OWNER ADDRESS t z CITY/STATE/ZIP <br /> CONTRACTOR PHONE <br /> CONTRACTOR ADDRESS A CITY/STATE/ZIP <br /> A <br /> LICENSE ❑[iC-42 ❑l'C-36 OTHER NUMBiER L EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATI N: COOrLjlrlateS X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: 11 RESIDENCE 1-1 COMMERCIAL I I OTHER <br /> NUMBER OF LIVING UNITS: // NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG CAPACITY �,�� D D 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 <br /> DISTANCE TO NEAREST WELL fi ft FOUNDATION—1 fl <br /> ft PROPERTY LINE <br /> L3 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 FOUNDATI ft PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER ? WIDTHS L ft DEPTH %t r' ft <br /> DISTANCE TO NEAREST WELL U t ft FOUNDATION �s.� ` 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 ODVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 9533-7697 <br /> SIGNED TITLE 40 u DATE <br /> r 1.1161 <br /> IN C ULN-Ty <br /> E O M N <br /> �D PARTMENT US Ek NA. Y <br /> Application Accepted By Date zz Area Employee ID# 0 <br /> Final Inspection By Date /o/!?/lg- ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump racter: <br /> OMMENTS <br /> r rPermit <br /> PESC Received ec Amoun Permit/Code INFO B ash Remitted Date Service Re uest# Invoice# ID# <br /> 991 pe <br /> fL'qb'-7 SP-00-7glo(y <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />