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.w <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 CALL(209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS CITY/ZIP -elLG�I <br /> CROSS STREET W= t7 e fS APN ! `7 S—yU� PARCEL SIZE <br /> OWNER NAME \ PHONE <br /> N <br /> OWNER ADDRESS CITY/STATE/ZIP <br /> CONTRACTOR Y'/ { ,��t�S ��C r PHONE �I/�/�"r�7SG! <br /> CONTRACTOR ADDRESS y, �i(� CITY/STATE/ZIP <br /> LICENSE L.11;C-42 I I'.'C-36 OTHER NUMBER EXPIRATION DATE �D�V <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y _ <br /> PERC TEST # BUILDING PERMIT#yam LAND USE APPLICATION# <br /> TYPE OF WORK: I 1 NEW INSTALLATION REPAIR/ADDITION 1 1 ENGINEER DESIGNED/ALTERNATIVE <br /> I REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM i DESTRUCTION <br /> INSTALLATION WILL SERVE: jo�,ESIDENCE I COMMERCIAL OTHER <br /> NUMBER OF LIVING UNITS: L 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: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ^ ft FOUNDATION ft PROPERTY LINE ft <br /> FILTER BED WIDTH 11 ft LENGTH ,/� ft DEPTH_ 11?11 ft <br /> DISTANCE TO NEAREST WELL' ft FOUNDATIONG, ft PROPERTY LINE �js) 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 WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> I HEREBY CERTIFY THAT 1 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 /> .MINIMUM48HOUR DVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL 209 953-7697 <br /> SIGNED TITLEG�Jj 1�tCC-OC-J'r DATE -7 lG, L <br /> FNr <br /> FO <br /> ,R 19 <br /> o Npu, ry <br /> ARTMENT USE ONLY <br /> Application AcceptejDetIv/cf <br /> Date_ Area Employee ID# <br /> Final Inspection By Date ll SPI/IALERMIT-Approved by <br /> Character of Soil to 3 Ft: Pitl ml Soil Character: <br /> COMMENTS ' 'Sex <br /> PE SC Received Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO B Cash Remitted Service Request# <br /> u --r /� as -1 rc/lq S dobi <br /> 42-01 ONSITE WASTEWATER TRTdINT SYSTEM PERMIT <br /> 4/14/18 <br />