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x ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> 9AN JOAOUIN 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 FROM DATE ISSUED <br /> JOB ADDRESS y0CIIT/Y�/ZIP PARCEL�✓� -�` <br /> CROSS STREET � � APN/ 6-{ 0( 0 SIZE <br /> �j <br /> OWNER NAME �'/ � � PHONE <br /> �LL�� JOEY �3�g�• <br /> OWNER ADDRESS CITY/STATE/ZIP <br /> CONTRACTOR /�� ti����� / � 1�d if"`li [- PHONE i <br /> 61 <br /> CONTRACTOR ADDRESS ��� Z � CITY/STATE/ZIP �f �✓1� L�,?Y' 1 �� <br /> LICENSE C-42 11 C-36 OTHER NUMBER �� 1 f EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> Fl 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: RESIDENCE I I COMMERCIAL Zf LI 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 /> 3 � <br /> DISTANCE TO NEAREST: WELL �Z� � 'z ft FOUNDATION S� ft PROPERTY LINE <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES 1 LEACHING CHAMBERS #OF LINES, LENGTH OF LINES �,1 ft <br /> DISTANCE TO NEAREST WELL / I_�L� �' ft FOUNDATION ft PROPERTY LINE ,S_T 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 It <br /> ;62l <br /> SEEPAGE PITS NUMBER WIDTH P ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION "/0 ? 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 A VANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 <br /> SIGNED TITLE L� L� DATE "' r <br /> E1VT <br /> Ven <br /> 2019 <br /> J q � <br /> N ANTy <br /> E T <br /> ENT <br /> EPARTMENT If SE Of N L Y <br /> Application AcceptedBDate Area Employee ID# � <br /> Final Inspection By Date 1 SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Su p Soil Character: <br /> COMMENTS O S ` &f:zV <br /> PE SC Received Ch Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO B Remitted Service Request# <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 5/5/17 <br />