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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)X9[53-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROMDATEISSUED <br /> JOB ADDRESS �/ tnN_A- IXIL"; CITYY/ZIPv�j �? /S�7 <br /> CROSS STREET 1�t7 �� _ APN_S1 ( v PARCEL SIZE sx- b <br /> OWNER NAME UT PHONE <br /> 111c.� <br /> OWNER ADDRESS � _�l„Si.//e•�i�e.e_ 1103CITY/STATE/ZIP <br /> CONTRACTOR X�-a / PHONE :36.9-5_0 12 <br /> 012 <br /> CONTRACTOR ADDRESS �� -J(,i1.G/G.L ///�� I�i�L' CITY/STATE/ZIP Sfu:,C'YT�ytJ <br /> LICENSE `fit-42 ❑CIC-36 OTHER NUMBER ySyUL/S EXPIRATION DATET/�J <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X ,, Y <br /> ❑ PERC TEST # LDING PERMIT VC LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION 0 REPAIR/ADDITION 11 ENGINEER DESIGNED/ALTERNATIVE <br /> L) REPLACEMENT ❑ OUT-OF-SERVICE SEPTIC SYSTEM ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: / NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> �- SEPTIC TANK TYPE/MFG -L- CAPACITY AA(,L4© gal #OF COMPARTMENTS _ <br /> I GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL f SJ ft FOUNDATION /Li ft PROPERTY LINE Sz ft <br /> t LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT C1 SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES ❑ LEACHING CHAMBERS #OF LINES_ LENGTH OF LINES S5 ft <br /> DISTANCE TO NEAREST WELL /S-O _ ft FOUNDATION e'�s ft PROPERTY LINE �O ' ft <br /> I FILTF_R 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 <br /> jft FOUNDATION ft PROPERTY LINE <br /> , <br /> SEEPAGE PITS NUMBER 3 WIDTH 7 ;/ ft DEPTH �S/ ft <br /> ,rb r � <br /> DISTANCE TO NEAREST WELL Zy� r' ft FOUNDATION 65 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 ADV NCE NOTICE REQUIRED FOR INSPECTIONS- PLEASE CALL (209)953-7697 <br /> SIGNED ? TITLE ���r>11�C DATE / <br /> IPA, <br /> )T <br /> N <br /> D p NTY <br /> F T <br /> c. -DEPARTMENT USE ONLY f <br /> Application Accepted av Date - <br /> __�Y�7 4 4 Employee ID# <br /> Final Inspection By Date 12i , <br /> 2i , � ❑ SPECT rL PERMIT-Approved by <br /> Character of Soil to of 3 t• F iN/S'Ump Soil Character: <br /> COMMENTS <br /> PE SC Received ie Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO B Cash Remitted Service Re uest# <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />