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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT �/` 1688 E.HAZELTON AVENUE-STOCKTON CA 95205•(209)468.3420 <br /> NON-REFUNDABLE PERMIT CAL 209 953-7897 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS �� C-1 G'l rT�Y/JZIP A <br /> CROSS STREET �2'(-� ��. APN �•;$ Y W'`�Q PARCEL SIZE •t I /'`'- p <br /> c <br /> OWNER NAME �L� z' PHONE ��Z>/, <br /> OWNER ADDRESS IS�-'� 1,(1'w �nSs `-'t', CITYISTATE//ZIP 1+ <br /> CONTRACTOR ��11L-C`� `�C ' 1 PHONE 14v5� ZIS--C I1CIi�s <br /> CONTRACTOR ADDRESS ISJ LS's\ AJ, '} CrTY/STATE/ZIP AIC'c�O.vt <br /> LICENSE ❑ C-42 ❑ C-36 OTHER.�.CMZ L ZZI( `NUMBER .���II: EXPIRATION DATE 131 Ze <br /> WATER TABLE DEPTH; � \ ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST # BUILDING PERMR# t-y Iq^Cc I cI LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM 2!' DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG CAPACITY Sv;: gal #OFCOMPARTMENTS \ <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL (i ft FOUNDATION S ft PROPERTY LINE 2LI 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 It PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL It 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 It DEPTH ft <br /> DISTANCE To NEAREST WELL ft FOUNDATION ft PROPERTY LINE It <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 HOUR ADVANCE NOTICE E 1 ED FOR INAPECTIONS-PLEASE CALL953-7697 <br /> SIGNED <br /> ,i_`E-__.._..__..� TITLE �,..¢.GT– .� DATE <br /> ��"Z <br /> fir <br /> L— f1v ly r <br /> RTTAL l• <br /> MCNT <br /> D PARTME SE <br /> Application Accepted By Date Area / Employee ID# <br /> Final Inspection By Date I / ❑ SPECIAL PER IT-Approved by <br /> Character of Soil to lh Pit1Sump oil Character: <br /> COMMENTS rt bo <br /> lV' Cru A Lv r ty <br /> PE SC R celved Check#/ Amount Perm t04y k,( _Ip <br /> Code INFO B Cash R miffed Dat Permit ID# tr Service Reguest# Invoice# �t <br /> SRoO�13 br Me <br /> 4/14/18 �� C? ^C ��� UL <br /> g ��l<C( /- ( ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />