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1 <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 /> JOB ADDRESS S D D ,CITY/ZIP / r <br /> CROSS STREET A AP �/0 s d PARCEL SIZE j <br /> OWNER NAME Gh%S 4, 44/-g4 PHONE zz <br /> v <br /> OWNER ADDRESS /� A/► nom,, CITY/STATE/ZIP <br /> CONTRACTOR /�'/•/!�`(A�-�- Cp/ C..�G SIC <br /> P/� PHONE <br /> J <br /> CONTRACTOR ADDRESS 7 C) `� ���V 'r CITY/STATE/ZIP /(/•y� C� J �s:1� <br /> LICENSE Ili C-42 ❑' C-36 OTHER NUMBER��� r r3 EXPIRATION DATE It / J / <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT I_. OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: I RESIDENCE I COMMERCIAL I 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 /> 'F LEACH LINES LEACHING CHAMBERS #OF LINES ,/� LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL /0.0 ft FOUNDATION Y ft PROPERTY LINE 3 S� r 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 'L ft LENGTH /Z ft DEPTH zc=> ft <br /> DISTANCE TO NEAREST WELL /SC7' ft FOUNDATION VO' ft PROPERTY LINE /U 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 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 OUR ADVANCE NOTICE REQUIRED FOR INSPE TIONS -PLEASE CALL 209 953-7697 c <br /> SIGNED TITLE r' DATE 'Z—2'-7 / <br /> All# T <br /> EN <br /> VED <br /> 1 '1 71112019 <br /> CARN A N E OrUN7Y <br /> R NT <br /> DEPARTMENTUSE ONLY f� <br /> Application Accepted By Date Area Employee ID# 61/� <br /> Final Inspection By Date ❑ SP AL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: f _ Phi, Soil Character: <br /> COMMENTS �'�1T C �(�„ Y�.� rw( _ n.� / 1, (7 / <br /> i <br /> PE SC Received Check# Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO B Remitted Service Request# <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />