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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 <br /> C EXPIR/E+Sp1 YEAR <br /> pFROM�DATE'ISSUED <br /> JOB ADDRESS ' % CITY/ZIP S o f C� CIS Z�-l <br /> ro A <br /> CROSS STREET A11A <br /> A APN �� � ' PARCEL SIZE 1 <br /> Acr <br /> OWNER NAME_ _8?-00q%r\x C.ornpanie.S - PHONE y <br /> OWNER ADDRESS IO(CM Tf\n f\i' A QolrHwdoor CITYISTATE/ZIP S�OC)CA�, (2A l �� <br /> CONTRACTOR YO e-2CLWhcj�-f�\JC�i!)�'S L(�Ci. PHONE `Ld9 7i9'b SIkCh <br /> CONTRACTOR ADDRESS t e--"' tT1 QA o� ^ CITYISTATE/ZIP SI-OC.� ^A 1`52-0v-0n,, ` 1I <br /> LICENSE 111-IC-42 ❑ <br /> 1-IC-42 FIC-36 OTHER q^7 <br /> V NUMBER 1 ! l2/P EXPIRATION DATE 2 - I'" <br /> WATER TABLE DEPTH: L 0 ft GEOGRAPHICAL INFORMATION: COor mates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# • BV LAND USE APPLICATION# <br /> TYPE OF WORK: b4 NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> 1.1 REPLACEMENT ❑ OUT-OF-SERVICE SEPTIC SYSTEM 11 DESTRUCTION _ <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: _ NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: 1 Z <br /> I <br /> SEPTIC TANK TYPE/MFG CAPACITY /6-00 gal #OF COMPARTMENTS <br /> I❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> f�3 LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES FI LEACHING CHAMBERS N #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION I ft PROPERTY LINE 30C3 ft <br /> Q 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 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 /> MJWNU0-4'8 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL 209 953-7697 <br /> SIGNED TITLE P� m0arrc,T4-DAT '3 qPLO _ <br /> �D <br /> 19 <br /> �R <br /> O p T �?' <br /> � F T <br /> DE ARTME SE NLY <br /> Application Accepted By Date Area '4Employee ID#� <br /> Final Inspection By Date PECIAL PERMIT-Approved by <br /> Character of Soil to Depth A Ft: P' Sump Soil C aracter: <br /> COMMENTS � / �S/`'t117 71 4 ;%r;a 0 ,ur�? &_0 <br /> lid f <br /> 4 <br /> ir <br /> PE SC Received Check#/ Amount ermit/ <br /> Code INFO B ash a fitted Date Service Re uest# Invoice# Permit ID# <br /> 42-01 <br /> ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4!/14/14/16 YY�� <br />