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t ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTFI DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 <br /> NON-REFUNDABLE PERMIT CA LL(209) 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 3 Aoo 4,t h At- � 1) r CITY/ZIP `i fce-y c4 <br /> CROSS STREET 1'YJ/ A P N -y(/L 7i PARCEL SIZE C <br /> 'I p <br /> OWNER NAME g0 ftM j_��r�L*r �/PHONE <br /> ' y <br /> OWNER ADDRESS *2.6'—' L4AIAle CITY/STATE/ZIP <br /> CONTRACTOR m ti c:�,s 4 d t. / j' PHONE S `� �v <br /> CONTRACTOR ADDRESS " <br /> - �- �( ( �S ,� CITY/STATE/ZIP //•)-A*7Ife-4 <br /> / <br /> LICENSE 11CIC-42 C-36 OTHERNUMBER (z, Y��� EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# • O LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION 1_I REPAIR/ADDITION Cl ENGINEER DESIGNED/ALTERNATIVE <br /> IJ REPLACEMENT 11 OUT-OF-SERVICE SEPTIC SYSTEM U DESTRUCTION <br /> INSTALLATION WILL SERVE: ESIDENCE ❑ COMMERCIAL ❑ OTHER - l <br /> NUMBER OF LIVING UNITS: /�I NUMBER OF BEDROOMS: ,..3 NUMBER OF EMPLOYEES: <br /> 01 SEPTIC TANK TYPE/MFG tQ L CAPACITY l�a� gal #OF COMPARTMENTS d <br /> f GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL 1601 ft FOUNDATION 40 ft PROPERTY LINE 40r ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> .. _-. �_ --- --_--- --- - _.. _ - —-...._.._ - --- - ---f... - <br /> LEACH LINES C) LEACHING CHAMBERS #OF LINES .3 LENGTH OF LINES lop ft <br /> DISTANCE TO NEAREST WELL_���-' _ ft FOUNDATION ft r ft PROPERTY LINE 061 ft <br /> G 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 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 4 OUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL 209)c9�53-7697 <br /> SIGNED TITLE 47� jtl�dt%�w7 r DATE ` f <br /> r <br /> o H ry <br /> EPARTMENT dayO ILY <br /> Application Accepted Date _ _ Area Employee ID# <br /> Afw'50A <br /> Final Inspection By — Date_ _ El SPE ALP RMIT-Approved by <br /> Character of Soil to Depth of 3 t: Pit/Sump Soil Character: <br /> COMMENTS' ; (JMp 17-IIAI <br /> J�W-M-dag'r-rt es ATY-f <br /> PE SC Receivedhe A\mount Date Permit/ Invoice# Permit ID# <br /> Code INFO By As h Remittecl Service Request# <br /> t �3S '' q- • I l <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />