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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 EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS /1/ CITY/ZIP <br /> /) m <br /> CROSS STREET Gf�7CJ / / �C!�CL/ APNUD � z5 <br /> .�'� PARCEL SIZ �t�/'� o <br /> OWNER NAME I L�/ .�(fGI I/'-'�i PHONE <br /> OWNER ADDRESS K O V lYY Y^VJIi'/ / CITY/STATE/ZIP L4--)Qt ('7 <br /> CONTRACTOR ,//�'l PHONE �) <br /> CONTRACTOR ADDRESS ��/>:-�✓" �"'� ' CITY/STATE/ZIP <br /> LICENSE L -42 IJC-36OTHER�"} NUMBER�S Vit; '/�S EXPIRATON DATE <br /> WATER TABLE DEPTH:IF)O 111 1 V It GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> C PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: `� NEW INSTALLATION REPAIRIADDITION ENGINEER DESIGNED/ALTERNATI E <br /> 1 REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE I_ COMMERCIAL x 1_I OTHER <br /> NUMBER OF LIVING UNITS: // NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> �CS SEPTIC TANK TYPE/MFG CAPACITY C� gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELLft FOUNDATION TO ft PROPERTY LINE l00 ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES 1' LEACHING CHAMBERS #OF LINES LENGTH OF LINES <br /> DISTANCE TO NEAREST WELL /CA-' It FOUNDATION�C' / ft PROPERTY LINE 1701 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 It FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST <br /> WELL ft FOUNDATION ft PROPERTY LINE ft <br /> SEEPAGE PITS NUMBER A ,� WIDTH�O7 l i� ft DEPTH 19<' " ft <br /> DISTANCE TO NEAREST WELL IID ft FOUNDATION t7 ft PROPERTY LINE (O�./�, 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 /> UR AQYANCE tjCMCE REQUIRED FOR INSPECTIONS-f!LEASE CALL(209)953-7697 <br /> SIGNED / - TITLE DATE <br /> %v <br /> I Co�N <br /> NTU/ 7Y <br /> TMENT <br /> Li <br /> D ARTMENT E NLY <br /> Application Accepted B Date Area Employee ID# <br /> Final Inspection By Iflee Date rJ—� u'4 L $PIEIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS- <br /> PE SC Received hec I Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO By Cash Remitted Service Re est# <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />