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A <br /> 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 EXPIR <br /> ES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS '� ki j4 1!) CITY/ZIP <br /> CROSS STREET N" APN I�` ` r V PARCEL SIZE < c <br /> OWNER NAME f I'U #Jr:js.0 f ET 7f COs-e. PHONE <br /> OWNER ADDRESS S Cin,. CITY/STATE/ZIP <br /> CONTRACTOR f`/�c 'S ��l1L.i�ti(/S� x' PHONE WRe- <br /> 0 Re-S- <br /> CONTRACTOR ADDRESS �� T � Ce'�J CITY/STATE/ZIP I^�"1,-4,A---,f-`Lc,A /S -3'- <br /> LICENSE Eli C-42 ❑I C-36 OTHER NUMBER Z�EXPIRATION DATE �15 a6 <br /> WATER TABLE DEPTH:'10 ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM I DESTRUCTION <br /> INSTALLATION WILL SERVE: 'B1/RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: 1 NUMBER OF BEDROOMS: 3 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 LINESLENGTH OF LINES r ft <br /> DISTANCE TO NEAREST WELL 1 ft FOUNDATION �6 1 ft PROPERTY LINE J'D i 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 /> UY SEEPAGE PITS NUMBER WIDTH 3b Cf ft DEPTH �S ft <br /> DISTANCE TO NEAREST WELL �� �1 ft FOUNDATION -i ' ft PROPERTY LINE �Ej 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 /> MINIMUM 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL 209 1953-7697 <br /> SIGNED TITLE d-0 IF C F s� DATE <br /> 3MIJOAQUI? C)UNTY <br /> TIE' <br /> EPARTMENT USE ONLY <br /> Application Accepted y AJhAADate Area L Employee ID# <br /> Final Inspection By Date ��iZGZi� ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 t: Pit/Sump Soil Character: <br /> COMMENTS K4,1, IjA1V r1r..* (VAAP <br /> PE SC Received Check#/ Amount Permit/ <br /> Code INFO B ash emittred Date Servi a Re uest# Invoice# Permit ID# <br /> u <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />