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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)95_3-7697 FORiNSPEC77ONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 9,_,e __ __CITY/zIP <br /> CROSS STREET _ APN�7r Zh0 /A <br /> PARCEL SIZE /A. p <br /> 0 <br /> �L F <br /> OWNERNAME l� __ ___,r7PHONE <br /> OWNER ADDRESS //rL/IGS/ ��s V_ CITY/STATE/ZIP �LJf/�7` G7w`f <br /> CONTRACTOR �j�iM7� a/L sag <br /> �g C _ PHONE IP 0r7-"f{� / 5741;1 3? <br /> CONTRACTOR ADDRESS 7JSQ G/50i4 02�:. _ ,CITY/STATE/ZIP" <br /> LICENSE ❑*42 0,'C-36 OTHER NUMBER A W!�EXPIRATION DATE <br /> WATER TABLE DEPT": it GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> D PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-OFSERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILLSERVE: RESIDENCE i I COMMERCIAL I I OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTICTANK TYPE/MFG�/_ CAPACITY gal #OF COMPARTMENTS__ <br /> ❑ GREASETRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL p0 it FOUNDATION S h PROPERTY LINE 30 op it <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES '.7 LEACHING CHAMBERS , #OF LINES_ LENGTH OF LINES it <br /> \ I i <br /> DISTANCE TO NEAREST WELL it FOUNDATION Lit PROPERTY LINE 30 it <br /> ❑ FILTER BED WIDTH it LENGTH it DEPTH it <br /> DISTANCE TO NEAREST WELL it FOUNDATION it PROPERTY LINE it <br /> ❑ MOUNDED WIDTH it LENGTH it DEPTH it <br /> DISTANCE TO NEAREST WELLit FOUNDATION it PROPERTY LINE IMP^ it <br /> ❑ SUMPS WIDTH it LF.NCTH__ it DEPTH / it <br /> DISTANCE TO NEAREST WELLit FOUNDATION it PROPERTY QUI, it <br /> it <br /> L1 DISPOSAL PONDS WIDTH it LENGTH it DEPTH FP <br /> DISTANCE TO NE EST WELL it FOUNDATION it PROPERTY DRETH Opp TM it <br /> SEEPAGE PITS NUMBER WIDTH _ft DEPTH 2-5— it <br /> DISTANCE TO NEAREST WELL 1,1 ' it FOUNDATION –2C i_—h PROPERTY UNE__3Os —it <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN <br /> JOAQUIN COUNTY ORDINANCES,STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br /> CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br /> WORKERS COMPENSATION LAWS. <br /> MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)/953-7697 !� <br /> SIGNED TITLE DATE10 <br /> p . <br /> ;001 W1.1 <br /> )EPAR <br /> s <br /> 2 <br /> TME T USE ONLY <br /> Application Accepted By Dete Area Employee ID#� <br /> Final Inspection By Date �Z _ ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth_ 3 Ft: PI Soll Character: <br /> COMMENTS <br /> PE SC Received Che Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO B ash Re d Service Re ueat# <br /> 2Z13(o 1 ► SRd �e6I , <br /> 42.01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 5/5/17 <br />