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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 11 YEAR FROM DATE ISSUED <br /> JOB ADDRESS Z��O; 1e- /�py�,-- J�� CITY/ZIP �AG�Y�Cb /�Zo! a <br /> CROSS STREET e!5 = e ,pJL APN_101.7�� PARCEL SIZE <br /> d <br /> v <br /> z <br /> OWNER NAME ZSf9- �'i�e �U/Ull/ _PHONE <br /> OWNER ADDRESS /� ^� /1 __/T✓�� / CITY/STATE/ZIP <br /> CONTRACTORCPHONE <br /> CONTRACTOR ADDRESS <br /> J / <br /> CITY/STATE/ZIP �1aCaiw <br /> LICENSE 00C-42 _Ii iC-36 OTHER NUMBER yO�/S EXPIRATION DATE_ <br /> WATER TABLE DEPTH: E/(/ L ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# ZCAND USE APPLICATION# <br /> TYPE OF WORK: §C NEW INSTALLATION I I REPAIR/ADDITION I1 ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT Il OUT-OF-SERVICE SEPTIC SYSTEM ❑ DESTRUCTION _ <br /> INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: I NUMBER OF BEDROOMS: 3 NUMBER OF EMPLOYEES: <br /> SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> CP- <br /> C3 GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL1ft FOUNDATION ft PROPERTY LINE SO" 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 5 ft <br /> DISTANCE TO NEAREST WELL JS6 ft FOUNDATION 76 ft PROPERTY LINE SZ 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 /> �, <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> 0/SEEPAGE PITS NUMBER WIDTH ft DEPTH � ft <br /> DISTANCE TO NEAREST WELL /5-0' ft FOUNDATION ft PROPERTY LINE 1�70 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 /> FAAE <br /> E <br /> s o_Q— <br /> O M N <br /> T E T 1H <br /> EPA RTMENT SE NLY <br /> Application Accepted B Date Area Employee ID#� <br /> Final Inspection By-7 fDate _�G� P SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft:- PI /Sump Soil Character: <br /> COMMENTS �-IJN 7 _0o 2jf iP 144WWA <br /> PE SC Received Che Amount Permit/ <br /> Code INFO B Cash Remitted Date Service Request# Invoice# Permit ID# <br /> �-3 Ga MIMI2 <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />