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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 /> JOB ADDRESS - 3 O i S O n e 1 'O'I-q CITY/ZIP -z9�n w� <br /> CROSS STREET n l�S APN_� p 7 /�� Yom/ PARCEL SIZE .S <br /> �77 - tv <br /> OWNER NAME _Q� C.p � � <br /> TltrrlPHONE Q 9 ' <br /> sl � <br /> OWNER ADDRESS <br /> �^ - Qr L� CITY/STATE/ZIP �j <br /> CONTRACTOR )g'l.�l/t�(;if' 1 LLc'-Ai+ lam-_� (� -nL/� PHONE �q P3c7 - /0� <br /> CONTRACTOR ADDRESS U 33'1 �� �"� 7�F;/P CITY/STATE/ZIP L 5 CA(¢�'► V� S <br /> LICENSE ❑1-iC-42 N 36 OTHER. _ NUMBER 9S 3-72(0 EXPIRATION DATE G 3I GV 2 <br /> WATER TABLE DEPTH:_ ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # -� BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: r I NEW INSTALLATION REPAIR/ADDITION ❑ ENGINEER DESIGNED IALTERNATIVE <br /> U REPLACEMENT 0 OUT-OF-SERVICE SEPTIC SYSTEM 11 DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: LNUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG �O/�� 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 /> L0. LEACH LINES Ci LEACHING CHAMBERS #OF LINES_ I LENGTH OF LINES tffS� ft <br /> DISTANCE TO NEAREST WELL'- ft FOUNDATION '-4- _ft PROPERTY LINE SI^� ft <br /> ❑ FILTER BED WIDTH ft LENGTH It 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 /> ❑ SUNIPS 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 ¢2)� ft DEPTH 2 S) ft <br /> DISTANCE TO NEAREST WELL J go + ft FOUNDATION O 'I" ft PROPERTY LINE 61 'f ft <br /> ]HER Y CERTIFY THAT I HAVE FNEPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> 11 STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MIJIM40AIADVANCENOTICEREQUIRED FOR INSPECTIONS - PLEASE CALL 209 953-7697 <br /> SIGNED TITLE DATE <br /> Al I <br /> ON E <br /> M <br /> HIWTHDEAT E <br /> Q PARTME S Y <br /> Application Accepted Date Area Employee ID# <br /> Final Inspection By Date11SPEC AL PF_RMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS �C�P_ c� <br /> OV <br /> PE SC Received Amount Date Permit/ Invoice# Permit ID# <br /> CodeINFO Cash Remitted Service Request# <br /> o <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />