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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 EXPIRES 'I YEAR FROM DATE ISSUED <br /> JOB ADDRESS 1 ( a8)L� �— }��J rr�-� CITY/ZIP <br /> CROSS STREET /V APN�J� f��Q �� PARCEL SIZE p <br /> c <br /> OWNER NAME M"Z,rr= Z--, fTz A PHONE r J <br /> OWNERADDRESS 7 `Y' Yu 5 lfDL CITY/STATE/ZIPJ <br /> M rrn <br /> CONTRACTOR y�_I442 C:ct iTxC `irI PHONE <br /> CONTRACTOR ADDRESS �7 `� CITY/STATE/ZIP <br /> LICENSE ❑AC-42 11LIC-36 OTHER NUMBEFL- ,V�_N EXPIRATION DATE `J,•� <br /> /fzir, �f <br /> WATER TABLE DEPTH:( _`O/ ft GEOGRAPHICAL INFORMATION: COO rdI es X Y <br /> ❑ PERC TEST # I BUILDING PERMIT# wl Iq 10 LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION R PAIR/ADDITION I_• ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM I i DESTRUCTION <br /> INSTALLATION WILL SERVE: �SIDENCE LJ COMMERCIAL I_1 OTHER <br /> 7 <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: j NUMBER OF EMPLOYEES: <br /> f3 SEPTIC TANK TYPE/MFG T 1T L CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL r5:7 ft FOUNDATION (7.1 ft PROPERTY LINE '75-'. <br /> Sr 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 7 / 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 LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL 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 HOUPUADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL 209 953-7697 C, <br /> SIGNED - TITLE �7 1(�C�=rC �r DATE C7 <br /> EA V/ IN <br /> H -IVF T <br /> MN <br /> HO LY <br /> Application Accepted Area Employee ID# <br /> Final Inspection By Date 12 Ll SPECIAL ERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> CO M M E NTS I q� � lfi�l�Tt lG/'l�I,_ /� � j� D�� GLIAAl <br /> -- ---- - = - S S - <br /> PE SC Received ec #/ Amount Permit/ <br /> Code INFO B Cash emitted Date Service Request <br /> # Invoice# Permit ID# <br /> VAJI�r 91 <br /> 2 <br /> 42-01 60V)At& r/!.r/ i w • i ole-' 0`O/ (/7- ` <br /> n ,,�( �j�,r�� SSIITE WASTEWATER 1TRTMNT SYSTEM PERMIT <br /> 4114/18 CL coC. V(ne L l' 0{,1 (wri l <br />