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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 CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS r' CITY/ZIP Q G <br /> j <br /> CROSS STREET �O �_L/\ l2 )APN �� (� PARCELSIZ y <br /> OWNER NAME CA cif c 1 PHONE <br /> OWNER ADDRESS p�' l t1I 1-��Gl.� l '�—d CITY/STATE/ZIP �L_`,"��Y 1��6 C-�C aq <br /> CONTRACTOR PHONE [,[ 6� <br /> CONTRACTOR ADDRESS CITY/STATE/ZIP <br /> LICENSE ❑CIC-42 ❑1IC-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ElPERC TEST # BUILDING PERMIT# D LAND USE APPLICATION## <br /> TYPE OF WORK: `*L NEW INSTALLATION i REPAIR/ADDITION I; ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM 'i.. DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE 1 COMMERCIAL OTHER <br /> NUMBER OF LIVING UNITS: 1 NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> 'EL SEPTIC TANK TYPE/MFG CAPACITY I #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY *,I #OFCOMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES ❑ LEACHING CHAMBERS #OF LINES "�� LENGTH OF LINES /� ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION / 11 "C ft PROPERTY LINE CL� 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 WIDT(H. DEPTH 7i� ft <br /> DISTANCE TO NEAREST WELL 4f h -r ft FOUNDATION J n fi ft PROPERTY LINE 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 /> MINIMUM 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 <br /> SIGNED G TITLE ATE <br /> �Nr <br /> VFD <br /> F v X19 <br /> Nry <br /> R 4 <br /> CDPARTMENT SE dNLY <br /> Application Accepted By Date Area Employee ID# ¢ K <br /> Final Inspection By Date El SPECIAL PERMIT-Approved by �G <br /> Character of Soil to Depth of 3 Ft: Pit/Sum Soil Character: ��� <br /> COMMENT Lam`/ <br /> �y <br /> A 12D We Cr u v U. NN, <br /> PE SC Received Check#/ Amount Date Permit/ Invoice# J Permit ID# <br /> Code INFO BV sh Remitted Service Request# <br /> 0,54, 47 <br /> 42-01 /���-7`� ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 [ ` / <br />