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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 95202-(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 11418 E. Coms- ocy— 12.T.). CITYIZIP ST cAr--r- S-7-1 Z' <br /> -1 <br /> CROSS STREET 13 CECti E(`— APN 0 1-1-30- -- - 7- PARCEL SIZE 1 p <br /> b <br /> OWNER NAME L-t)Gilh GrlQ-IL--Lo / y� PHONE X131 - 13�� N <br /> OWNER ADDRESS �I�� � y LL'`7 le ✓• CITY/STATE/ZIP (^'1 id D�-;N `'A 9 5 7s <br /> CONTRACTOR QAK-' <br /> ` E�'7 L- PHONE 3I9�1 <br /> CONTRACTOR ADDRESS 40-+ w' Vp CITY/STATE/ZIP L-o " C^ <br /> LICENSE .IC-42 .JC-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST # 3 BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION !. REPAWADDITION ENGINEER DESIGNED/ALERNATIVE <br /> REPLACEMENT DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE COMMERCIAL 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 L 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 It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH it <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE It <br /> ❑ SUMPS WIDTH It LENGTH ft DEPTH It <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL it FOUNDATION ft PROPERTY LINE It <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 /> IMU OUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953.7697 <br /> SIGNED L TITLE C-PJ$(/L-1-r\-r DATE 1 t'-'- "I <br /> t1 <br /> t\ <br /> \A <br /> \}\b <br /> \ t 37.07' <br /> m4 PAYMENT <br /> x y'` RECEIVED <br /> ,V 16 2018 <br /> -SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL <br /> e s \ LTH DEPARTMENT <br /> t <br /> BEECHER POAO <br /> l <br /> t <br /> DEPARTMENT�l1JE O LYS a Area Employee ID# <br /> Application Accepted By Date (( ,�I o <br /> Final Inspection By Date C1 I-Z I SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of3 Ft: Pit/Sump Soil Character: <br /> COMMENTS <br /> PE SC Received eck#/ Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO By emitted Service Reauest# <br /> 42-Ot ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />