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r ' <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 53-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS �23 ,! CITY/ZIP G! <br /> a <br /> j / R <br /> CROSS STREET `J Lf u7 APN a o 7O 7 O� ( PARCEL SIZE Y <br /> OWNER NAME Gc�G� ',J�C'Pr PHONE ao`�—.3�Q� �3a� z <br /> OWNER ADDRESS I //^�' 'Jv V O CITY/STATE/ZIPS C 1- CA— Z, <br /> CONTRACTOR���7 Q�l 7/V�u^ ll�'�/ ` PHONE <br /> CONTRACTOR <br /> `ADDRESS ✓(lA O/ ��� ' CITY/STATE/ZIP <br /> LICENSE ❑XC-42 El- C-36 OTHER NUMBER /Cf EXPIRATION DATE 7 ��—✓/ <br /> WATER TABLE DEPTH ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: _ NEW INSTALLATION REPAIRIADDITION ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE I I COMMERCIAL I I OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: V NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG �//�/JohAM* CAPACITY /,-?0 C) 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 /> f <br /> DISTANCE TO NEAREST WELL l UD / ft FOUNDATION SO ft PROPERTY LINE ICI:5' J-/ 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 LIFE ft <br /> �Cl <br /> I�\J SEEPAGE PITS NUMBER � WIDTH .3 ft DEPTH ft <br /> DISTANCE TO NEAREST WELL /�g 0 / ft FOUNDATION 50 � 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 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 <br /> SIGNED // TITLE DATE <br /> Nr <br /> Fo <br /> q 19 <br /> rIrcc <br /> DEPARTMENT USE QNLY <br /> Application Accepted By Date Area Employee ID# �� <br /> Final Inspection By tfflDate :1 SP AL PERMIT-Approved by <br /> Character of Soil to D pth of 3 t: Pi ump Soil Charact r. p <br /> COMMENTS >,7 36/* <br /> 0 (� 1 S <br /> PE SC ReceivedChec Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO By Remitted Service Request# <br /> Z 3�a 7 g <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />