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e <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 PERMITCALL 209 953-7697 FOR INSPECTIONS C EXPIRES 'I YEAR FROM DATE ISSUED <br /> JOB ADDRESS Gni//�� Q CITY/ZIP 5i cr-Ki'-7'1 {F+ 7s)-is- <br /> CROSS <br /> CROSS STREET A t^�6C� X19-jt{� (�� ^ APN /may ���f 0 � <br /> PARCEL SIZE _ <br /> OWNER NAME- VV I -(��-eL4, �/ ! '� C1 d,CCe•/ PHONE <br /> OWNER ADDRESS JAi�C CITY/STATE/ZIP <br /> t c a } � _ <br /> CONTRACTOR c tL.0 � __- !' �,(_ Y� PHONE_ `T- (�! �Ce <br /> CONTRACTOR ADDRESS_ �C S _ CITY/STATE/ZIP <br /> LICENSE 11LIC-42 ❑OC-36 OTHER_ NUMBER &o XPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y _ <br /> ❑ PERC TEST # BUILDING PERMIT#,- LAND USE APPLICATION# <br /> TYPE OF WORK: P NEW INSTALLATION "0' REPAIR/ADDITION LI ENGINEER DESIGNED/ALTERNATIVE <br /> iJ REPLACEMENT I.I OUT-OF-SERVICE SEPTIC SYSTEM I..I DESTRUCTION <br /> INSTALLATION WILL SERVE: ESIDENCE El COMMERCIAL El OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG 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 /> LEACH LINES 1-1 LEACHING CHAMBERS #OF LINES t LENGTH OF LINES 140 ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION to t ft PROPERTY LINE SOS 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 LINE ft <br /> SEEPAGE PITS NUMBER a WIDTH �L III ft DEPTH 2S I ft <br /> DISTANCE TO NEAREST WELL I 5b ft FOUNDATION 101 ft PROPERTY LINE <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 T� <br /> 0 <br /> ,, 19 <br /> R C U <br /> P <br /> T <br /> DEPARTMENTUSE NLY <br /> Application Accepted Date Area Employee ID# go <br /> Final Inspection By Date ElSP IAL PERMIT-Approved by <br /> Character of Soil to Depth oft: WSilmp Soil Character: <br /> COMMENTS <br /> ��tFA w0flO - l <br /> PE SC Received Check Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO Remitted Service Request# <br /> Wo J' S P-MOCR)777 <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />