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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTFi DEPARTIVIENI 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 <br /> BION-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS CITY/ZIP <br /> z t� <br /> CROSS STREET �i J APN QD / J PARCEL SIZE <br /> �f fie, r <br /> OWNER NAME PHONE ' AZ <br /> OWNER ADDRESS CITY/STATE/ZIP <br /> CONTRACTOR 7 _ PHONE sl"I Q.3� �/ <br /> i <br /> CONTRACTOR ADDRESS /022 CITY/STATE/ZIP <br /> LICENSE 1-11-7C-42 []PC-36 OTHER_ NUMBER EXPIRATION DATE <br /> � Jt <br /> WATER TABLE DEPTH: — ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> I — PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: 11 NEW INSTALLATION REPAIR/ADDITION Cl ENGINEER DESIGNED/ALTERNATIVE <br /> 1-1 REPLACEMENT ❑ OUT-OF-SERVICE SEPTIC SYSTEM ❑ DESTRUCTION _ <br /> INSTALLATION WILL SERVE: P!!5—RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> 0 SEPTIC TANK TYPE/MFG CAPACI Y gal #OF COMPARTMENTS <br /> 0 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 D LEACHING CHAMBERS #OF LINES_2� LENGTH OF LINES _ ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION 16 14- 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 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 NEAR T WELL //ft FOUNDATION ft PROPERTY LINE ft <br /> SEEPAGE PITS NUMBER WIDTH 3y ft DEPTH ��� 1 �— ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION J 6 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 /> MINI 48 HOURAlAIANCE NOLICE REQUIRED FOR INSPECTIONS — PLEASE CALL 209 953-7697 <br /> SIGNED _ TITLE ` �y DATE -' <br /> Azr <br /> O <br /> ]YAW 01E T <br /> H <br /> PARTMENT SE ONLY <br /> Application Accepted B _ _ _ Date Area Employee ID#�— <br /> Final Inspection By Date7i 91 ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 F Pit/Sump Soil Character: <br /> COMMENTS "171zz <br /> of <br /> PE SC Received ec Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO B Cash fRemitted Service Request# <br /> � c ►I i81� 5 1(.P <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />