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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 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS J /t� / L/��I r% CITY/ZIP <br /> — — — ' rn <br /> CROSS STREET ),—," LU/�P L' 4zV APN '0440— PARCEL SIZE _ j <br /> i o <br /> OWNER NAME /1 �,�4 y^� ,.�1 I�Ti%` IN o rn� _PHONE <br /> OWNER ADDRESS I�_� O �llh�� CITY/STATE/ZIP <br /> CONTRACTOR '491,el: rL�__ _ PHONE <br /> CONTRACTOR ADDRESS .,•—�— t' � � i �> CITY/STATE/ZIP l�i��.✓I� '� �` ��i <br /> LICENSE 42 iC-36 OTHER NUMBER ` /CfEXPIRATION DATE <br /> t-- <br /> r <br /> WATER TABLE DEPTH: Itoft GEOGRAPHICAL INFORMATION: Coordinates X__---- Y <br /> I PERC TEST It BUILDING PERMIT# -_ _ LAND USE APPLICATION#___ <br /> TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNE P�&� <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE 1.1 COMMERCIAL I OTHER VA <br /> e/ <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS:_) NUMBER OF EMPLO <br /> El SEPTICTANK TYPE/MFG __.._ CAPACITY gal #OF COMP /N"N C. N] <br /> ❑ GREASE TRAP TYPE/MFG _ CAPACITY _ gal #OF COMPARTMENTS ZP'4-l.`w <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 /> ...._.. <br /> LEACH LINES E LEACHING CHAMBERS It OF LINES LENGTH OF LINES 5 1 It <br /> DISTANCE TO NEAREST WELL L� Zy ft FOUNDATION J ft PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It <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 /> SEEPAGE PITS NUMBER l WIDTH �l ft DEPTH ft <br /> DISTANCE TO NEAREST WELLZ� ft FOUNDATION ft PROPERTY LINE i� 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 /> MIAMUM24HOU ADV CE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 <br /> 51GNE TITLEG�L� DATE <br /> I� �' L! DEPARTMENT U E ONLY <br /> Application AccepteAof <br /> Date ( Area Employe ID# <br /> Final Inspection By Date ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to it/Sump Soil Character: <br /> COMMENTS T�' �� '�--1 N� L� QI� <br /> PE SC ReceivedCheckAmount Date Permit/ Invoice# Permit ID# <br /> Code INFO s Remitted Service Request# <br /> 60 <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/24/12 <br />