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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 J CALL 209 953-J7697"FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS i 31 9b/J N1 l nowe-IQ �7}�. ylw/Gt�O I'�J2 CITY/ZZII jP� )Q <br /> CROSS STREET �i7llLttn/r APIN V��Z- PARCEL SIZE p <br /> OWNER NAME ��J�� PHONE <br /> OWNER ADDRESS CITY/STATE/ZIP <br /> CONTRACTOR �7�� y / ,C/�/j/'� l�lG PHONE <br /> CONTRACTOR ADDRESS / �%"�7 CITY/STATE/ZIP <br /> LICENSE ❑�k42 ❑'.IC-36 OTHER NUMBER VS<VYS EXPIRATION DATE dt'z3���1' <br /> WATER TABLE DEPTH:_ �ftlft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION P11- REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM 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 LEACHING CHAMBERS '�77 #OF LINES LENGTH OF LINES '7��r�o ft <br /> DISTANCE TO NEAREST WELL /1X)/' ft FOUNDATION 66 " ft PROPERTY LINE m � 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 /> ,4L,SUMPS WIDTH 7 ft LENGTH /� ft DEPTH lU It <br /> DISTANCE TO NEAREST WELL 25-0' ft FOUNDATION ft PROPERTY LINE .?C>/ ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> �BEEPAGE PITS Potruise t ft <br /> DISTANCE TO NEAREST WELL 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 /> MINI UM 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS -PLEASE CALL 209 953-7697 <br /> SIGNED -� TITLE Ga9 ?? DATE <br /> SAN,OAQL I <br /> E 14T <br /> DF ARTME N T IJ SE N Y <br /> Application Accepted By Date Area Employee ID# <br /> Final Inspection By j Date r C SPEC/ L PERMIT-Approved by <br /> Character of Soil to Depth o 3 Ft.. Pit/Su p Soil Character: <br /> COMMENTS <br /> U �- �- - -� <br /> PE SC Received Check#/ Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO B Cash Remitted Service Request# <br /> 90 142-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />