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ISZ l-� ISZ�ec�c91 F/-rotes+ <br /> hAles <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 L � CALL <br /> 209 953-7697 FOR INSPECTIONS '^ EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS {Z OOI moi• 4.41&4+VJ6[ '19 CITYIZIP 1V 1 T CA 95330 �' <br /> CROSS STREETG7V CJ"r r��p ��• APN 20�- S3 PARCEL SIZE 19-12 <br /> — <br /> CROSS <br /> OWNER NAME PHONE -229—(.,52-5� <br /> T 9 <br /> OWNER ADDRESSS12oo) D• Vh6ff " CITYISTATEIZIP M'4 N-N-CJ , (fOk- <br /> -45�!CONTRACTOR AC� Gs/iV /eoarJ 4-1ZvOloPHONE —&02 <br /> CONTRACTOR ADDRESS &0 4ytzge }y /V/ G v <br /> c <br /> 0 CITYISTATEIZIP !Jgzve- y <br /> LICENSE 0f]C-42 U! C-36• OTHER NUMBER EXPIRATION DATE � <br /> WATER TABLE DEPTH: y✓i It GEOGRAPHICAL INFORMATION: Coordinates X 3'7• '56,77 <br /> y —12D•2ZZ3 <br /> PERC TEST # { BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: 3K NEW INSTALLATION I; REPAIRIADDITION I_' ENGINEER DESIGNED[ALTERNATIVE <br /> C REPLACEMENT I OUT-OF-SERVICE SEPTIC SYSTEM L, DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE *)(COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: �_ NUMBER OF BEDROOMS: �0� NUMBER OF EMPLOYEES:_ _ <br /> SEPTIC TANK TYPEIMFG CAPACITY �/Sb� gal #OF COMPARTMENTS l <br /> ❑ GREASETRAP TYPEIMFG CAPACITY COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL R F it PROPERTY LINE ft <br /> C] LIFTSTATION SIZE TYPE OF PUMP PKG LANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> X LEACH LINES yC LEACHING CHAMBERS #OF LINES LENGTH OF LINES IOD It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE it <br /> ❑ FILTER BED WIDTH H LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH It LENGTH R DEPTH ft <br /> DISTANCE TO NEAREST WELL it FOUNDATION ft PROPERTY LINE It <br /> G SUMPS WIDTH It LENGTH It DEPTH it <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH R LENGTH ft DEPTH it <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 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 IN PE T NS-PLEASE CALL <br /> �¢2 53-7697 p <br /> SIGNED TITLE P/PO,JEGT �'JVE//NEwTE 7'�b' / <br /> 4 <br /> Q '2019 <br /> CO <br /> FpgR��V'7Y <br /> NT <br /> Q PPA RT Al ENT 0 SE ID N L Y <br /> Application Accepted Date 7 Area ployee ID#_ _Qi <br /> T <br /> Final Inspection By Date ❑ SP CIAL PERMIT-Approved by <br /> Character of Soil t D pth 3 Ft: Pi u 'I Character: <br /> COMMENTS A `' L <br /> PE S Received heck Amount Date Permit! Invoice# Permit ID# <br /> Code INFO B Remitted Service Request# <br /> 2 S' <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4114119 <br />