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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 HWr 2-( CITY/ZIP � <br /> CROSS STREET [ APN lr-?R T ZOO 3 PARCEL SIZE 0-4 <br /> O <br /> O <br /> A <br /> OWNER NAME /-'y'c'I7'/l���' n PHONE <br /> OWNER ADDRESS yy�� �n��,,1^^V�^�'z1 <br /> �:^± YL. CITY/STATE/ZIP' / j�`zi u <br /> CONTRACTOR A � �/L t-�J l X l �" f ^T//L1// rZ PHONE `4 1,S- U'1 '32-25))Q '3 �� Q/' <br /> CONTRACTOR ADDRESS 40 A- c`T'IWF-L L �l• p CITY/STATE/ZIP JA-s/F0—A,;-N c/Sn-, CA. 7Z // <br /> LICENSE [IF-IC-4211F-C-36 OTHER NUMBERS?05 Z EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION I ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM I i DESTRUCTION <br /> INSTALLATION WILL SERVE: Ll RESIDENCE I I COMMERCIAL I I 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 ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES 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 /> ❑ 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 /> MINIMIX 48 HOUR ADVANCE NOTICE REQUIRED FDR INSPECTIONS -PLEASE CALL 209 953-76,97 <br /> SIGNED TITLE DATE O <br /> U <br /> A E T <br /> EA <br /> DEPARTME T USE ONLY <br /> Application Accepted B Date Area "/ Employee ID# <br /> Final Inspection By Date ■ SSE IAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Pitt//Sump Soil Cmharctr: <br /> COMMENTS <br /> L L <br /> PE SC Received V Cf6w.,6k Amount t Permit/ Invoice# Permit ID# <br /> Code INFO By y Cash Remitted <br /> Service Request# <br /> Z q8o S <br /> RE <br /> �Z Z �Z 442j'- 1 Uv- <br /> �� �,�'j (��l � � I� -� ONSITE W t �T d A SYSTEM PERMIT <br /> 4/14/18 V�J � <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT <br />