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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 EXPIRE <br /> S <br /> 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS -l 3 /ilaily,�„”d CITY/ZIP a /mss of <br /> Ac <br /> � <br /> I � <br /> CROSS STREET A�C�L/l / APN Ol 7�Z9 --n� PARCEL SIZE ` 4GCYPS <br /> OWNER NAME '�i PHONE <br /> n <br /> OWNER ADDRESSCITY/STATE/ZIP <br /> {}�� <br /> CONTRACTOR I fi-0 1611 <br /> E— PHONE ( yq�y+77b - <br /> � <br /> CONTRACTOR ADDRESS LnC7 S I�YNQ I�� ��• CITY/STATE/ZIP JCl��, CA (��S <br /> LICENSE 11. 0-42 ERIC-36 OTHER NUMBER EXPIRATION DATE <br /> ri <br /> WATER TABLE DEPTH: I I `130 ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> J PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION REPAIRIADDITION LL ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ( I RESIDENCE I 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 n LEACHING CHAMBERS #OF LINES LENGTH OF LINES P.4�rA�r <br /> 1 <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft _ I <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH �ft'��/T.A; <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE <br /> E3MOUNDED WIDTH ft LENGTH ft DEPTH &A A. 4L j19 <br /> {f% <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE AQ4FjUI 6U <br /> Ll SUMPS WIDTH ft LENGTH ft DEPTH &ALTy n�!4FNtTA Ty <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE V7. <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 /> MAVIMUM 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 <br /> SIGNED A/ TITLE—Sia DATE W 9 <br /> Note All residential structures have beer <br /> dernulrstred. <br /> 64' 150' L•,.; ,c,r. <br /> '8• <br /> Perc Hole Location <br /> 233' <br /> i <br /> 1_6 <br /> F Domcstx Wel <br /> omen•-.._ <br /> DEPA RTMENTUSE ONL <br /> Application Accepted By Date f 2 q11 q Area Employee ID# ���-- <br /> Final Inspection By - Date ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil t Depth of 3 Ft: Pit/Sump Soil Ch ter* <br /> COMMENTS �/� ✓LD1 DYI rGL 77 I, oc <br /> PE SC Received hec Amount D to Permit/ Invoice# Permit ID# <br /> Code INFO By ash Remitted inz Z Service Request# <br /> ?,ZZ 2p 0 1 <br /> 343 <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />