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7 <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 / tf"yL�,'F-t'ctr I-vu CITY/ZIP.`'4f�/ I�� 12 <br /> CROSS STREET r�1��fl+�•�I�IZA � APNIC J�7jS� _ PARCEL SIZE <br /> OWNER NAME �i/V ` EEL _ _ PHONE <br /> OWNER ADDRESSC CITY/STATE/ZIP <br /> Lor✓SrRrtcTryN 3 SCCG ZN� c 2 <br /> CONTRACTOR��i_ / PHONE <br /> CONTRACTOR/ADDRESS 8577 _/no��2SSoN �,Z-6 K DA sir fC CITY/STATE/ZIP.5wA't"r-'w7 <br /> LICENSE C 42 C-36 OTHER NUMBER _ N '' EXPIRATION DATE VCe202 O <br /> WATER TABLE DEPTH: q_s_ ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: / NEW INSTALLATION ly REPAIR/ADDITION ENGINEER DESIGN D/ALTERRRN4TTII�VE <br /> !/ REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTIO <br /> INSTALLATION WILL SERVE: RESIDENCE COMMERCIAL OTHER <br /> NUMBER OF LIVING UNITS:_ NUMBER OF BEDROOMS: Z._(Q�JfDj,50UMBER OF EMPLOYEES: <br /> SEPTIC TANK TYPE/MFG ' z ��'�✓� CAPACITY ?0gal #OF COMPARTMENTS <br /> 7 <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 /> 1a LEACH LINES LEACHING CHAMBERS -:ZW1�r=TR4-MR #OF LINES 1;_1 LENGTH OF LINES �U ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION /!3 r ft PROPERTY LINE 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 .:21 WIDTH y? ft DEPTH 217-) ft <br /> DISTANCE To NEAREST WELL / S}>' ft FOUNDATION 5-e," ft PROPERTY LINE S ft <br /> 1 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 /> SIGNED TITLE DATE <br /> F <br /> UUIN <br /> C01JN ITY <br /> H THD M.P <br /> EPAR TMENVI tISE afNLY <br /> Application Accepted Date Area Employee ID#_4� <br /> r <br /> Final Inspection By1 ' Date f SPECIAL PERMIT-Approved by <br /> Character of Soil to epth f 3 Ft: Pi Su p Sol Character: <br /> COMMENTS <br /> PE SC Received Check#/ Amount Permit/ <br /> Code INFO B Cash Remitted Date Service Request# Invoice# Permit ID# <br /> Olt ax 169 <br /> lav <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />