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/ .5::. <br /> pV <br /> 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 <br /> PERMIT \ L CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS CITY/ZnIP 2/7 �S^oZ/ S <br /> CROSS STREET <br /> PARCEL SIZE CAPN "I 4Z�7 c <br /> OWNER NAME L Y1 u l� 1'��'��S�/1 1 PHONE <br /> OWNER ADDRESS y Z S• !��?/�lC E CITY/STATE/ZIP <br /> CONTRACTOR PHONE <br /> CONTRACTOR ADDRESS CITY/STATE/ZIP <br /> LICENSE ❑I C-42 11:.0-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT i OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: I 1 RESIDENCE I) COMMERCIAL OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG CAPACITY 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 LEACHING CHAMBERS #OF LINES LENGTH OF LINES 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 <br /> 13SUMPS WIDTH ft LENGTH ft DEPTH T[ <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE <br /> L3DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH 5 7n.., ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LIFE..054Q,,,- fly ft <br /> L3 SEEPAGE PITS NUMBER WIDTH ft DEPTH hE4�� iV aP N ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE "let 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 /> MINIMU 8 HOUR ADV N NOTICE REQUIRED FOR INS ECTIONS -PLEASE CALL 20 53-7697 <br /> SIGNED ` � 9 TITLE G� DATE <br /> in I <br /> 1 <br /> r <br /> ,. ARTMENT USE ONLY <br /> Application Accepted By V14 Date Area Employee ID#_ —t> <br /> Final Inspection By i DateD SP CIAL PERMIT-Approved by <br /> Character of Soil to Depth of Pit/ ump Soil Character: <br /> COMMENTS <br /> Gt(ic19Lf Vit u L/,v.X- <br /> l� S Pt e7— L LA02 0 tc'7� Nee-a Ike-t tt sixCso o D In c.-p— AwYe W6 9 �0, /S <br /> PE SC Received Check#/ Amount Permit] Invoice <br /> Code INFO B Cash Remitted Date Service Request# Invoice# Permit ID# <br /> 71v S— �.DC7 a 25 l`j 5►Q `` O L 5 <br /> e 1/1 gIl9 <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />