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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT ' <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH OEPARTOMM """"'1'MFE.HAZELTON AVENUE-STOCKTON CA 95206-(209)468.3420 <br /> NON-REFUNDABLE PERMIT CALL 2D9 953-7697FOR INSPEEC77I�ON5 EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOBADDRESSZ�t may,/P5o <br /> -y/', —ily, , r•r��J ' �z^7.�� <br /> CROSS STREET ��NV f-� 511 V A �1� APN[1{ 1 PARCEL SIZE !/ v <br /> V L LLL o <br /> OWNER NAME <br /> { -I,K "A D A Q�t-� G ,� PHONE <br /> OWNER ADDRESS b"I ls� 1"H�+y�t- S,tV A. (--I CITYISTATEIZIP A Co. <br /> CONTRACTOR V4F-<0 G1JNSl SSAC."k-AINCt'�1 L PHONE <br /> y' �✓�'��� J <br /> CONTRACTOR ADDRESS 7 W�I Ij� 1 CITYISTATE21P <br /> LICENSE �,. C-42 i.. C-36 OTHER A NUMBER EXPIRATION DATE ZoZJ J <br /> WATER TABLE DEPTH: I V J V v it GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST # BUILDING PERMIT# 0 LAND USE APPLICATION# _ <br /> TYPE OF WORK: NEW INSTALLATION ":i REPAIR/ADDITION - ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT .) OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: J.,RESIDENCE COMMERCIAL LI OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: D <br /> tj SEPTIC TANK TYPE/MFG �"�t"' CAPACITY b�J gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL R FOUNDATION t J I It PROPERTY LINE 10 I ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> O LEACH LINES LEACHING CHAMBERS (N\t,1 rfC'TJ r-�#OF LINES .21LENGTH OF LINES�It <br /> DISTANCE To NEAREST WELL tam, ft FOUNDATION IJ` ft PROPERTY LINE ZS It <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH h LENGTH ft DEPTH 1 <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH J� <br /> DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE L <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE R CO <br /> C9 SEEPAGE PITS NUMBER WIDTH '40 N It DEPTH 2 S � azl#E r <br /> DISTANCE TO NEAREST WELL rr.�\ ft FOUNDATION �'J` ft PROPERTY LINE 5 <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS <br /> LAWS AND RULES AND WORK <br /> WILL BE DONE I <br /> OF SAN N COUNTY.ACCORDANCE <br /> WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> STAT <br /> MINIMUM 24 HOURADVANCE NOTICE REQUIRED FOR INSPECTIONS-�PLEASE CALL 209 953 7697 <br /> DATE <br /> SIGNED <br /> TITLE \ t2.5.1Je�+ / <br /> PAR M NT Area Employee ID#-� <br /> / _ <br /> Application Accepted By <br /> Finallnspection By Date_ <br /> / <br /> Date /S J `. SPECIAL PERMIT-Approv by <br /> pit/Sump Soil Character. <br /> Character of Soil to Depth of 3 Ft: G! <br /> COMMENTS <br /> ----._...........--------- <br /> PE SC Received a Amount Permltl Invoice# Permit ID# <br /> Code INFO RXA <br /> ash Remitted a Service Re uest# <br /> J7 z <br /> ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 42-01 <br /> 4124/12 <br />