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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 CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> `' o f <br /> JOB ADDRESS /•`7y0o I'I�, �0e uS� Tf2�'�„� CITY/ZIP C �S2 <br /> ke-dlt en n-ti L� APN OSr' v� <br /> CROSS STREET PARCEL SIZE � <br /> OWNER NAME W4t7 REW 1- 4A/,kAiz� /-&-79- PHONE v <br /> v. <br /> OWNER ADDRESS SfT/f7C` CITY/STATE/ZIP <br /> CONTRACTOR, L CcmS-,t-A9� � � ; Zy PHON Ilf, <br /> CONTRACTOR ADDRESS os� flJo�,2 xrm. y IZF�I( 7�q5�. 'L 2,)OCITY/STATE/ZIP SftC.<gya�tr/�/�C /qs (Tzr' <br /> LICENSE ❑1,1;42 1111C-36 OTHER NUMBER Vfib EXPIRATION DATE <br /> WATER TABLE DEPTH:p Q V ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> FE PERC TEST # BUILDING PERMIT# 7 0 0 LAND USE APPLICATION# <br /> TYPE OF WORK: Z NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT Z OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: VRESIDENCE ❑ COMMERCIAL OTHER • <br /> /62�t <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: LSI NUMBER OF EMPLOYEES: <br /> SEPTIC TANK TYPE/MFG CAPACITY �� gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS y — <br /> DISTA <br /> T: VVELL <br /> ft PROPERTY LINE <br /> ❑ NCE TO NEARES LIFT STATION SIZE TYPE OF P MU P ftft <br /> ❑ PKG TX PLANFOUNDATIONT L3 OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES r/ LEACHING CHAMBERSS,,,I #OF LINES LENGTH OF LINES <br /> DISTANCE TO NEAREST WELL /0 b ft FOUNDATION 20 ft PROPERTY LINE 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 /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> SEEPAGE PITS NUMBER I WIDTH 4 ft DEPTH 2 $ I ft <br /> DISTANCE TO NEAREST WELL ISO* 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 /> MINIMUM 48 ADVANCE NOTICE REQUIRED FOR INSPECTIONS -PLEASE CALL 209 953-7697 <br /> SIGNED TITLE DATE 07/0'F �1 <br /> AiT <br /> O <br /> WV <br /> 9 <br /> H / ° 1, <br /> Fq C <br /> N <br /> DEPARTMENT S N L Y <br /> Application Accepted By Date � Area e Employee ID# <br /> Final Inspection By Date 1 /-❑ SPEC AL PERMIT-Approved by <br /> Character of Soil to epth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS <br /> PE SC Received Check#/ Amount Permit/Code INFO B Ca emit d Date Service Request# Invoice# Permit ID# <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />