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T 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 209 953-7697 FOR INSPECTIONS ^^ EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS �i^n-k98 CITY/ZIP E,:; <br /> CROSS STREWLA" 20' APN ���� i0 PARCEL SIZE ! C <br /> OWNER NAME /J `A WAY <br /> PHONE <br /> OWNER ADDRESS °/i f// I CITY/STATE/ZIP Alk 41� <br /> CONTRACTOR tiS-e-► PHONE 1 5 <br /> t���_- A <br /> 4 <br /> CONTRACTOR ADDRESS _� CHIC �SS� ` CITY/STATE/ZIP YJ/�IZ�VIV�� � <br /> LICENSE ❑I C-42 III IC-36 OTHER NUMBER - K EXPIRATION DATE <br /> WATER TABLE DEPTH: ��I d ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> CI PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: I I NEW INSTALLATION I REPAIR/ADDITION I. ENGINEER DESI NED/ALTERNATI E <br /> V11, REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: ';/RESIDENCE I 1 COMM E�CIAL I OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> Q/SEPTIC TANK TYPE/MFG Q��- CAPACITY nn gal #OF COMPARTMENTS_! <br /> ❑ GREASE TRAP TYPE/MFG y, CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL �� Y ft FOUNDATION U5 ft PROPERTY LINE (0/31 ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> 0"LEACH LINES I I LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL 10-61- ft FOUNDATION ft PROPERTY LINE I ft <br /> ❑ FILTER BED WIDTH It LENGTH ft DEPTH it <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE w <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTHc1\.�"It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE I�ltt <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH APP_1 n ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LI ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH {.��E�M��QVINC 11Au�ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE^LTy n j ""'SAL ft <br /> SEEPAGE PITS NUMBER - WIDTH ft DEPTH a�1 �r ft <br /> DISTANCE TO NEAREST WELL ( 1 ft FOUNDATION , Z1 ft PROPERTY LINE 1161 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 OUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 a� <br /> SIGNED TITLEDATE (� <br /> 1 Z <br /> w <br /> i. <br /> D E PARTMENTAISS ONLY <br /> Application Accepted Date Wto 10 Area Employee ID# <br /> Final Inspection By 72C= .- Date !� 1-1SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTST't ?l .�L>G/ AID Obi , (.ul'AneV IQ,69,* L1010 <br /> STGt7 ,L �tl <br /> f <br /> PE SC Received hec Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO B s Remitted Service Request# <br /> J <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 5/5/17 <br />