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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 /> O <br /> JOB ADDRESS uol� ' � AML to CITYIZIP (1[M <br /> L <br /> CROSS STREET 'r/?i J N%10� APN �� PARCEL SIZE <br /> OWNER NAME '[QTle Ox Cl'AS+ JM1S&Vwwf-"f l �S� "'fir"„ PHONE��! ,,�/J U <br /> OWNER ADDRESS <br /> '^`_1) �71 (bJ. "(t�K � --CITY/STATE/ZIP p�C/QG� )CA 95--AD - <br /> CONTRACTOR LJd/� �IJ lQ� SQpA - _ PHONE � / 4tSn ) 95 <br /> E <br /> CONTRACTOR ADDRESS ��?C_ O� / _ _ / CITY/STATE/ZIP S�-�k C,4, /.7 fiI <br /> LICENSE 1_11 C-42 ❑FIC-36 OTHER_ �L` _ NUMBER &2/-Vp EXPIRATION DATES/( 9 <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT I# LAND USE APPLICATION# <br /> TYPE OF WORK: P NEW INSTALLATION REPAIRIADDITION ENGINEER DESIGNED/ALTERNAT E <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM ry DESTRUCTION <br /> INSTALLATION WILL SERVE: 11 RESIDENCE 11 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 T):PLANT 0 SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ® I-EACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> © FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE c ft <br /> G3 iL70UNDED WIDTH ft LENGTH ft DEPTH E ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> © SUMPS WIDTH ft LENGTH ft DEPTH A44 vft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINEA ft <br /> ® � <br /> DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH JOAC), J— ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERT/rI IRONON1Y ft <br /> ® <br /> T19�E q�l E SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WF_LL ft FOUNDATION ft 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 /> MI HOUR ADVANCE NOTICE REQUIRED FOR INSPE TIONS -f PLEASE CALL (209)953 7097 <br /> SIGNED TITLE � ac DATE 5 <br /> al <br /> C <br /> PARTMENT S O 'VLY C <br /> Application Accepted ByfijjmkDate L Area % Employee ID# <br /> 401 'L <br /> Final Inspection By Date 1 12* P 1 SPE AL PERMIT-Approved by <br /> Character of Soil t D th of 3 Ft: Pit/Amp Soil Character: <br /> COMMENTS <br /> PE Sc Received Amount Permit/ <br /> Code INFO <br /> By_ Cash emitted Date Service Rec nest# Invoice# Permit ID# <br /> J 3 95 5 21 S(L00 Il5 <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />