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• <br /> 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 �OSOO fYA)gIAit/ 1ZD CITY/ZIP �2E^1cN l'.9nIP, ('�l 9ppS23f H <br /> .r� <br /> CROSS STREET O//'f (C APN PARCEL SIZE a <br /> d <br /> d <br /> OWNER NAME 41AA/IION1DcUtCT!-9,d Co • PHONE IaCA <br /> x n CA <br /> OWNER ADDRESS <br /> 7O0/ LJI �SyQ/� CITY/STATE/ZIP S taut MiNTD_ M 93FjZ7 <br /> CONTRACTOR L' ES�!£�/ 69A11U1-TjNL17 PHONE da!?-'¢O2 -1,6, S2 <br /> CONTRACTOR ADDRESS �'D • R o X�3^714 CITY/STATE/ZIP '1 (R-Leg 4,61A <br /> LICENSE 11❑C-42 011C-36 OTHER NUMBER 7.!P479 EXPIRATION DATE 6 ��'Zp2 O <br /> WAT RTABLEDEPTH: ~ Z7 ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: U NEW INSTALLATION U REPAIRIADDITION U ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ 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 /> ❑ 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 ff <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT '❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES l LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION 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 /> ❑ HiOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> Ll SUNIPS WIDTH ft LENGTH it 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 /> ❑ <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 /> WH4 48 ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL 209 953-7 97 <br /> SIGNED TITLE?/(//L gA�41 AlfSER DATE / <br /> 170 <br /> 9 A16 <br /> Oq <br /> R N H <br /> DEPARTMENTUSE ONLY 7�y. <br /> Application Accepted Date Area lhployee ID# y� <br /> Final Inspection By Date U12,1110 ❑ SP IAL PERMIT-Approved by <br /> Character of Soil to Depth f 3 Ft: I Pit Sump Soil Character: <br /> COMMENTS t9 'YVL4 Fti <br /> PE SC Received Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO B Cash Remitted Service Request# <br /> �- <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />