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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 1 + L /'SCALL 209 953-7697 FOR INSPECTIONS /� EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOBADDRESS :2-44716 Ja IL.LI�I�I Cwy-� CITY/ZIP �-c-CI1" 522 n <br /> CROSS STREET C�tS� hccnt Pon,-1 APIN PARCEL SIZE C <br /> OWNER NAME YI�I u Y i 1 PHONE V l S 7 U - 12_70 rn <br /> M <br /> OWNER ADDRESS {_� -O 4 I V ,1G hari f 0e u f CITY/STATE/ZIP /A a -r►i ISO. cA / &192- Z() <br /> CONTRACTOR W a4f1 �a sf L3-(G((k hv� PHONE 2-0) 3�n� . 7' 394 <br /> X73 94 o <br /> CONTRACTOR ADDRESS 33 k6w(wPll U f CITY/STATE/ZIP Lod, ICA 2-CM <br /> WATERLICENSE ❑ 'C-42 ❑i'C-36 OTHER— A, NUMBER 5'1 1 EXPIRATION DATE 2020 <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LLAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION I REPAIR/ADDITION I ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT I OUT-OF-SERVICE SEPTIC SYSTEM I DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> SEPTIC TANK TYPE/MFG r CAPACITY u gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES J LEACHING CHAMBERS kY4A YCL-6tS #OF LINES 3 LENGTH OF LINES �S I ft <br /> DISTANCE TO NEAREST WELL 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 /> J DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> �d SEEPAGE PITS NUMBER WIDTH Tft DEPTH 2) µ <br /> DISTANCE TO NEAREST WELL �S�J ft FOUNDATION 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 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (2091953-7697 <br /> SIGNED C l.. L 1 G4 L►� TITLE�'f CA- DATE <br /> oq 2019 <br /> G N OVNTy <br /> p Tq� <br /> FNT <br /> EPARTMENT USE ONLY <br /> Application Accepted y Date Area Employee ID#� <br /> Final Inspection By Date GI ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to epth of 3 Ft: Pidsump Soil Character: <br /> COMMENTS <br /> 6 <br /> PE SC Received hec Amount Permit/ <br /> Code INFO B ash emitt d Date Service Request# Invoice# Permit ID# <br /> 1,76,3aSK002 1 a a7 <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />