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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-REFUNDABLEPERMIT <br /> ` A CALL 209 953-7697 FOR INSPECTIONS �+�� EX1 PIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS y,O DO M ton✓�O Ave— /� CITY/ZIP,�}c%VC-L TO 1n <br /> CROSS STREET N C S O ✓1 APNI �J — 64C� !/ PARCEL SIZE '- <br /> C <br /> -7-31, <br /> G <br /> OWNER NAME S R WI►Vl �1 6 1 / ,>e-✓1 Gk JJCL 111 -L PHONE(20q)(66 7-31,S- <br /> w <br /> OWNER ADDRESS CITY/STATE/ZIP <br /> CONTRACTOR / PHONE <br /> CONTRACTOR ADDRESS CITY/STATE/ZIP <br /> LICENSE 11-IC-42 111'C-36 OTHER NUMBER <br /> NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: I!D" I 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/ALTERNATIVE <br /> REPLACEMENT I OUT-OF-SERVICE SEPTIC SYSTEM I' DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE 11COMMERCIAL 11 OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> L3SEPTIC TANK TYPE/MFG C`1<4r1A'8 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``__D LENGTH OF LINES S� ft <br /> DISTANCE TO NEAREST WELL_? ( <br /> ft FOUNDATION ft PROPERTY LINE -79 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 FOUND TION ft PROPERTY LINE ft <br /> SEEPAGE PITS NUMBER ;?7 WIDTH 21 ft DEPTH Z�L I ft <br /> DISTANCE TO NEAREST WEL1­_4D ft FOUNDATION ft PROPERTY LINE ft <br /> 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 /> MINI !48 HOUR A V E NOTICE RE IRED FOR INSPECTIONS - PLEASE CALL 2 -76 7 <br /> SIGNE TITLE DATE I C' <br /> IRONFAENTA. <br /> -70-EIA R TM E ALTd SE OF N Y <br /> Application Accepted B t Date l Area Employee ID#� <br /> Final Inspection ByDate 19 <br /> ❑ SPE IAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS. U/(/'�C=7E /f�i'r�. /(ia (/1/t�,t,5 Q(�S�(f£�J� U,q !ZW/ �f(�! <br /> S <br /> L61 CCN S vF riij SL0AjA-4 ('F1110M <br /> PE SC Received Check# Amount Permit/ <br /> Code INFO B sh Fiernitted Date Service Request# Invoice# Permit ID# <br /> l 8 I�1 (�12 10 <br /> 42-01 f-1'7 Pj� h � O`J 8"c �"''• ` ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 �'Y"� .V <br /> old exp�-�-v� �d fps -� ✓�c��,�-g I l 4W/9 <br />