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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 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS �J S% �L�j���/��/} CITY/ZIP <br /> CROSS STREET �` �!�/\T� / APN l/ D / �vO 277 PARCEL SIZE _57. O_S <br /> v <br /> / C <br /> OWNER NAME I f�G�[�S�P Z'.'r D PHONE <br /> OWNER ADDRESS CITY/STATE/ZIP <br /> CONTRACTOR ' ��/ J�� PHONE <br /> CONTRACTOR ADDRESS � CITY/STATE/ZIP <br /> LICENSE ( h C-42 1_111C-36 OTHER NUMBER 7b 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 I I ENGINEER DESIGNED IALTERNATIV <br /> 1.1 REPLACEMENT LI OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION _ <br /> INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIA ❑ OTHER i <br /> NUMBER OF LIVING UNITS: I NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> SEPTICTANK TYPE/MFG ,2, CAPACITY �«J gal #OFCOMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL / bU -T' ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT D SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> /d LEACH LINES ❑ LEACHING CHAMBERS #OF LINES A_ LENGTH OF LINES gzp ft <br /> DISTANCE TO NEAREST WELL / <br /> 71-71- ft FOUNDATION /��,Z. ft PROPERTY LINE jr— �-Z ft <br /> G FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH It 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 a WIDTH 5�iL l ft DEPTH <br /> s1) T ft <br /> !I <br /> r 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 /> MINIMLM18 HOUR ADVANCE NOT CEREQUIRED FOR INSPECTIONS - PLEASE 9ALL (2092953-7697 <br /> SIGNED TITLE �j � DATESJ 0 -+ <br /> N <br /> M N <br /> ID P <br /> DEPARTMENT USE ONLY C' <br /> Application Accepted By Date Area Employee ID# <br /> Final Inspection ByDate 1 1 �T El L PERMIT-Approved by <br /> Character of Soil to Depth f 3 Ft: Pit/Sump Soil Character: <br /> C M ENTS Z <br /> won 1/1 LO <br /> PE SC Received Check#/ Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO A Y A as Remitted Service Request# <br /> 2zS 1 S`2 3to <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />