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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 EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS CITY/ZIP ( .UL Y V 11 J( ) v' <br /> H <br /> R�{ L �/J�� '1 C � <br /> CROSS STREET 1) C-Y-- � APN �/�� ^V PARCEL SIZE /- p <br /> OWNER NAME 1 1 ck &4 PHONE L,CCI ' 3(o6i r \'2-6L <br /> OWNER ADDRE�SS/��/� 1�T11J LLD(i r�.1`U/ )Iod 'K4 CITY/STATE/ZIP /� 2A <br /> CONTRACTOR Y sl' c C�-f 1C�P PHONE ,+`� "/^'Q�J� <br /> CONTRACTOR ADDRESS 3� MGIX We11 ��-• CITY/STATE/ZIP l XA ICA 1 6115 0 <br /> LICENSE EIEC-42 ❑0C-36 OTHER_ A\ NUMBER 1 EXPIRATION DATE OZO <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 ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE 1-1 COMMERCIAL I I OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: I 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\A ►l 0(A\tYcj #OF LINES_� LENGTH OF LINES (c 15 1-1 ft <br /> DISTANCE TO NEAREST WELL IOC'FY ft FOUNDATION ��ft PROPERTY LINE %1 "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 /> SEEPAGE PITS NUMBER I WIDTH 1 (-o)) ''11 ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION I V 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 /> MINIMUM 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS -PLEASE CALL 209 953-7697 <br /> SIGNED TITLE DATE <br /> P <br /> I <br /> N <br /> r EPT- <br /> ARTMENJUS ONLY <br /> Application Accepted 11K4 Date Area Employee ID#� <br /> Final Inspection By !29 DateSPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 35 v`'\ C l�'� I SOME SAND PiUSump Soil haracter: <br /> COMMENTS <br /> b <br /> 1 <br /> PEW SC Receiv Gheck#/ Amount Permit/ # Permit ID# <br /> Code INFO B as Remitted Date Service Request# <br /> �l <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />