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>A <br /> 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 Lr 1 5��1 CITY/ZIPgZ <br /> / ZCS <br /> CROSS STREET �¢ p APN ( J7— �/� PARCEL SIZE p <br /> OWNER NAME PHONE <br /> m <br /> OWNER ADDRESS 1' ►J G%4��,4 /fi 7 �13 !lT CITY/STATE/ZIP <br /> { <br /> CONTRACTOR Y1�M 1I,K�& 4GIG�bL_ �rQ+' PHONE hsir-� feS_ <br /> CONTRACTOR ADDRESS AN "�� (OS :S CITY/STATE/ZIP <br /> LICENSE 11LIC-42 ❑IIC-36 OTHER — NUMBER EXPIRATION DATE Cf 1 <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: EW INSTALLATION REPAIR/ADDITION I ! ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL C 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 /> EACH LINES LEACHING CHAMBERS #OF LINES� LENGTH OF LINES J�fS' ft <br /> DISTANCE TO NEAREST WELL1/')Z)I ft FOUNDATION Ito t ft PROPERTY LINE [S 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 /> W" <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> 11� SEEPAGE PITS NUMBER 7 WIDTH 4 {' ft DEPTH';LS i ft <br /> DISTANCE TO NEAREST WELL kj 7y ft FOUNDATION I&(I ft PROPERTY LINE S 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 /> MINIMUM 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL (209)953-7697 <br /> SIGNED TITLE DATE <br /> NT <br /> FO <br /> p�9 <br /> '8 <br /> Q11 1A, <br /> C N 0 N)y <br /> R <br /> T <br /> EPARTMENT USE ONLY � <br /> Application Accepted Date C Area Employee ID# �XiJ <br /> r <br /> Final Inspection ByDate T f� CjI C SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS / <br /> v JN <br /> PE SC Received Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO Iqy Cash Remitted Service Request# <br /> I .1Rowios <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />