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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 <br /> �� �• � [EXPIRES 1 rYEAR FR�OM DATE perISSUED <br /> JOB ADDRESS CITY/ZIP C- <br /> D6D5 PARCEL SIZECROSS STREET n4. C <br /> m <br /> OWNER NAME LJAJ PHONE ,lr t yCl� v <br /> OWNER ADDRESS CITY/STATE/ZIP <br /> �^'� <br /> CONTRACTOR Y ► 1 f�K��S �6 j5t,a-g PHONE /� S <br /> CONTRACTOR ADDRESS r 18, 4-A CITY/STATE/ZIP j/�-yl"-.,0' .,e✓rA <br /> LICENSE ❑i C-42 ❑I'C-36 OTHER NUMBERc7cli CKSSq EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION i I ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM I I DESTRUCTION <br /> INSTALLATION WILL SERVE: )RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: 1 NUMBER OF BEDROOMS: -3 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: VVELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> W LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES_�l ft <br /> DISTANCE TO NEAREST WELL Il 60-,Y ft FOUNDATION 161 ft PROPERTY LINEI 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 /> � i <br /> SEEPAGE PITS NUMBER 14— WIDTH .7�Cf ft DEPTH ft <br /> DISTANCE TO NEAREST WELL I fi}S ft FOUNDATION (t31 ft PROPERTY LINES ft <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATIONAND 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 HODR14EIVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7 97 <br /> SIGNED TITLE ��� � –/� DATEcel— <br /> , <br /> 10 <br /> '11C A <br /> V / <br /> H <br /> F <br /> EPARTME T VSE OALL Y <br /> Application Accepted y Date l AreaEmployee ID# <br /> Final Inspection By Date ❑ SPE IAL PERMIT-Approved by <br /> Character of Soil to epth of 3 Ft: / Pit/Sump Soil Character: <br /> COMMENTS'Z f/ (jA j2E2! 411 A�/h <br /> SV S u <br /> PE SC ReceivedCheck Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO By_ ash Remitted Service Request# <br /> 0 kjl La 1`� ►q U <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />