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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 <br /> _ y\\CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS V"�� CITY/ZIP L — - <br /> 7 <br /> CROSS STREETc �S Na <br /> APN Q (� <br /> / PP[AyR,CEL SIZE <br /> OWNER NAME ---5 �1(�5 PHONE�W <br /> OWNER ADDRESS �tplya o2.Ja �,- CITY/STATE/ZIP <br /> CONTRACTOR 1 'tD17ESa-' �jn a:v P.Jl' �(� .�.L. PHONE <br /> CONTRACTOR ADDRESS t}j—( 1--t lavv�v�.l 1:.T'T Cj CITY/STATE/ZIP�{�'M�'.,:jTC- <br /> LICENSE L C-42 IJ C-36 OTHER C'2-1 NUMBERZ?-0%(­k0 EXPIRATION DATE <br /> WATER TABLE DEPTH: It 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 OUT-OF$ERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: I I RESIDENCE L COMMERCIAL LI 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 It PROPERTY LINE It <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES i I LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft N*�DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE �. <br /> ❑ FILTER BED WIDTH It LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL It FOUNDATION It PROPERTY LINE A <br /> ❑ MOUNDED WIDTH ft LENGTH It DEPTH <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH It DEPTH �Q 20 n <br /> DISTANCE To NEAREST WELL It FOUNDATION ft PROPERTY LINE /N COU J <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH MF;V, �7Y <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It RTMF/�/ <br /> LlSEEPAGE PITS NUMBER WIDTH ft DEPTH <br /> DISTANCE TO NEAREST WELL It FOUNDATION It 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 INSPECTIONS PLEASE CALL(209)953-769 <br /> SIGNED �---�'� ��-1� —�— TITLE�IZJ S2;�- �yAILlI DATE -� <br /> lol <br /> i <br /> ^ —DEPA RTMENEN- <br /> Application Accepted By Date Area Employee ID#_te� <br /> Final Inspection By Date L1 SPE AL PERM/IT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil C)laracte. <br /> COMMENTS S� 1 I! <br /> PE SC Received Check Amount Date Permit/ Invoice# Permit ION <br /> Code INFO Qy, Remitted Service Re uest# <br /> 26— 10 A S 0 2 <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />