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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 2 EXPIRES 1 YEAR/FROM DATE ISSUED <br /> JOB ADDRESS i CITY/ZII�P�/ v TGGA�_4Z 1Z ' Ie Zf J <br /> CROSS STREET APN �� 1 PARCEL SIZE v <br /> OWNER NAME S��/gin//L(�%i1//% PHONE a_e <br /> OWNER ADDRESS CITYISTATE/ZIP <br /> CONTRACTOR �/ rj //����� r6/ i0 L I�/ - PHONE <br /> v / � <br /> CONTRACTOR ADDRESS /U�^e �!/.�/�l'or_ b CITY/STATE/ZIP <br /> LICENSE ❑F'C-42 F11-IC-36 OTHER_A NUMBER O EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT LAND USE APPLICATION# <br /> TYPE OF WORK: I NEW INSTALLATION REPAIR/ADDITION I ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT 11 OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: F1 RESIDENCE COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: N <br /> UMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> SEPTIC TANK TYPE/MFG y �--- CAPACITY gal #OF COMPARTMENTS `7 <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY ✓ gal #OF COMPARTMENTS <br /> 7 <br /> DISTANCE TO NEAREST: WELL / ft FOUNDATION !� /7Z' <br /> ft PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES I LEACHING CHAMBERS #OF LINES LENGTH OF LINES S s` ft <br /> DISTANCE TO NEAREST WELL fi ft FOUNDATION 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 <br /> INE ft <br /> SEEPAGE PITS NUMBER 6 WIDTH ? ft DEPTH;2e_/ ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE �1 -L ft <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATI N AND T4 WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> M/ 48 HOUR ADV NCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL 209 953-7697 <br /> SIGNED TITLE G��� DATE <br /> ft- <br /> E N <br /> N <br /> J m PARTMENT SE 01N.LY <br /> Application Accepted ByDate Area (/ l� Employee ID#— <br /> Final Inspection By Date ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Dep f 3 Ft Pit/Sump Soil Character: <br /> COMMENTS <br /> Pyr' re 01A C <br /> PE SC Received QhecW Amount Permit/ <br /> Code INFO B Cash a 'tte Date Service Re e t# Invoice# Permit ID# <br /> 1 <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />