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l <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 /> JOBADDRESS �0�/7 rel/ c. i CITY/ZIP S�xlG <br /> CROSS STREETgl f ���C L�C� APN Q PARCEL SIZE • p <br /> � v <br /> OWNER NAME / - <br /> �/�-a��N P—U GL PHONE �6� <br /> OWNER ADDRESS CITY/STATE/ZIP <br /> CONTRACTOR �r/�� ;9L �/ l�..////CG/��//II �/ryC��G 1, PHONE 36�- s627 <br /> CONTRACTOR ADDRESS �7/� e7Uil�/CeW /�/�/L f�.CC,� CITY/STATE/ZIP SL"y <br /> LICENSE ❑ 4-42 ❑. C-36 OTHER NUMBER �SS�yS EXPIRATION DATE &'jzzC. Z <br /> WATER TABLE DEPTH:N ` ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> FE PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION I ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL C OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: ✓ NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG C/S CAPACITY gal #OF COMPARTMENTS Z <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL It FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> F- LEACH LINES LEACHING CHAMBERS #OF LINES_� LENGTH OF LINES ZDV ft <br /> DISTANCE TO NEAREST WELL� ft FOUNDATION yD ft PROPERTY LINE <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 It <br /> ,SEEPAGE PITS NUMBER -17- WIDTH 3 ft DEPTH d'g' ft <br /> DISTANCE TO NEAREST WELL It FOUNDATION STD ft PROPERTY LINE D 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 /> MINIM M 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS -PLEASE CALL 209 953-7697 <br /> SIGNED TITLE DATE <br /> r <br /> 0 <br /> h N <br /> qD ARTMENT WS E CVNLY <br /> Application Accepted By 27 ate Area Employee ID#� <br /> Final Inspection By Date C SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/ ump Soil Character: <br /> COMMENTS - 0. d G <br /> 06—A6 <br /> O&aA I- <br /> PE' SC Received Chec Amount I <br /> Date Permit/ Invoice# Permit ID# <br /> Code INFO By ash Remitted Service Request# <br /> G <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />