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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 /> NONREFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS W CITY/ZIP /' J Z <br /> CROSS STREET APN � Z ( U 6 2_ PARCEL SIZE 1% O,^ <br /> J - d <br /> OWNER NAME A� /^ I I l !�J pe Z PHONE ter' <br /> OWNER ADDRESS / f CITY/STATE/ZIP _ <br /> CONTRACTOR_ 1� ^^ve-IdJI G J� �' PHONE 5— <br /> CONTRACTOR ADDRESST'�/'f�✓. Gv..)04-. CITY/STATE/ZIP .r- <br /> LICENSE 130C-42 ❑LTC-36 OTHER 14 NUMBER_W5_yY3 EXPIRATION DATE <br /> ( lf' <br /> WATER TABLE DEPTH:ti 2 ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # ( BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDITION U ENGINEER DESIGNED/ALTERNATIVE / <br /> 9? REPLACEMENT 0 OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: / NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> 0 SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS 2 <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL. ft FOUNDATION ft PROPERTY LINE Yep ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT P, SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES A' LEACHING CHAMBERS 5f6a4np OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> l� FILTER BED WIDTH 13 ft LENGTH .5,(C2 ft DEPTH ft <br /> DISTANCE TO NEAREST WELL/,0 0• It FOUNDATION J�` 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 OUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL L2091953-7697 <br /> SIGNED / TITLE CDT�/+ U/ DATE J 2 <br /> Orr <br /> — 0 <br /> N QI <br /> - A A <br /> � T <br /> ^ <br /> D EP A R T M E N TAJ S N L Y <br /> Application Accepted By Date Area Employee ID# <br /> Final Inspection By Date G ❑ BPE IAL PERMIT-Approved by <br /> Character of Soil to Depth Jf 3 Ft: Pittsump Soil Character: <br /> COMMENTS <br /> PE SC Received eck#/ Amount Permit/ <br /> Code INFO B s Remitted Date Service Request# Invoice# Permit ID# <br /> � S U2�•��1 S 3 <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />