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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQU?.N COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 <br /> NON-REFUNDABLE <br /> jPEE,R,MIT T L CALL 209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> 14 <br /> JOB ADDRESS r/`� �� 1/u ST 1 h �aG/ CITY/ZIP 0 <br /> CROSS STREET �l RcIald APN V 1300( PARCEL SIZE ' v <br /> OWNER NAME (j11 y!k-_ PHONE <br /> OWNER ADDRESS r I0 /1 I / J�,.d ( /�a&t- CITY/STATE/ZIP <br /> ^^V� lIv! ..Y�//,L PHONE doet -34 <br /> CONTRACTOR` IYR <br /> CONTRACTOR ADDRESS 92a <br /> /LC 0 uo"1 D,-. CITY/STATE/ZIP <br /> LICENSE I_IYC-42 1 1 C-36 OTHER NUMBER 4 SY96 EXPIRATION DATE___q^ <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 ENGINEER DESIGKD/ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> Ava- <br /> INSTALLATION WILL SERVE: X RESIDENCE [I COMMERCIAL L OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG L C/.S77,y CAPACITY gal #OF COMP' <br /> ART E�� <br /> L3 GREASETRAP TYPE/MFG CAPACITY gal #OF COA7ll✓ Q(o lS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPT�IRNM OUNry ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCU 1FSTEM) <br /> LEACH LINES I ' LEACHING CHAMBERS #OF LINES� LENGTH OF LINES � ft <br /> DISTANCE TO NEAREST WELL 15 O ' ft FOUNDATION �".� / ft PROPERTY LINE Soo ft <br /> ❑ 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 FOUNDATION ft PROPERTY LINE ft <br /> XSEEPAGE PITS NUMBER a WIDTH 3 ' ft DEPTH e�57 ft <br /> DISTANCE TO NEAREST WELL CPO0' ft FOUNDATION 62 ft PROPERTY LINE ft <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 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 <br /> S NED TITLE G Y DATE 1 —d — I9 <br /> S <br /> .J T1111-1 <br /> P <br /> 0 <br /> bEPARTMENT USE ONLY <br /> Application Accepted By Date Area Employee ID# <br /> Final Inspection By Date Gt I I SPECT L PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: it/SILimp Soil Character: <br /> COMMENTS <br /> PE SC Received etheck#0 b Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO B Remitted Service Re uest# <br /> 1 Z+0 115' o W3 <br /> 2Z [O <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 5/5/17 <br />