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ONSITE WASTEWATER TREATMI E-NT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 9'5205-(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 5 Q 7-1c Z� CITY/ZIP <br /> / <br /> CROSS STREET A.1",/X. <br /> 6�//X. k oI APIN �J ^�q PARCEL SIZE O �y <br /> "77 / RC1 <br /> OWNER NAME ��/�!n!T �� /)PHOONNE �I"', <br /> OWNER ADDRESS L,TS� C �y'�SfOt Gr CITY/STATE/ZIPy�/( �� <br /> CONTRACTOR PHONE <br /> TT�� /� PHONE <br /> CONTRACTOR ADDRESS �` CITY/STATE/ZIP Cali/ Alf �7 3W <br /> LICENSE UEC-42 110C-36 OTHER NUMBER 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 ❑ REPAIRIADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ OUT-OF-SERVICE SEPTIC SYSTEM -x- DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> SEPTIC TANK TYPE/MFG 7�'' CAPACITY gal #OF COMPARTMENTS C� <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 /> D LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE 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 /> 13 SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> 1 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 /> MINIMUM 48 H ' R A+ MANCE NOTICE REQUIRED FOR INSPECTIONS- PLEASE CALL�209)953-7697 <br /> SIGNED �- TITLE0 111' DATE V <br /> E N O <br /> H E <br /> i <br /> DEPARTMENT USE ONLY q ] ) <br /> Application Accepted Zv Z <br /> Date 3 -aArea Employee ID# �1/Fy1�e <br /> Final Inspection By Date � 09� ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS e }I L ook;5}t d r sfiaehle x sj n- jJeta k <br /> 5 11 R- ro'� 5 ��. �rT ped uc �•� <br /> u � , <br /> PE SC Received hec Amount ate Permit/ Invoice# Permit ID# <br /> Code INFO By Cash Remitted Service Re uest# <br /> LIV-1 075 I5� C <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4114/18 <br />