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14 <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 <br /> iVON-REFUNDABLE PERMIT CALL(209) 953-7697 FOR INSPECTIONS / J EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS .J L4 �jM / CITY/ZIP (� <br /> CROSS STREET y(elfQ APN OdS J(J PARCEL SIZE 1 I �j <br /> OWNER NAME 0 0U0r PHONE <br /> 'Box <br /> ^7 1 � <br /> OWNER ADDRESS Fo /J�.'BBox I// Q � CITY/STATE/ZIP <br /> 1c)-,thy <br /> CONTRACTOR "'r l V T PHONE P"/ l� r/J /',f <br /> CONTRACTOR ADDRESS 2 / 7 6 Tom'^' / CITY/STATEIZIP �I" �Ir- IC4, C* <br /> r �!_--CVz/Sr <br /> LICENSE ❑�-42 ❑l_1C-3ti 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 ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/,ALTERNATIVE <br /> 11 REPLACEMENT 71 OUT-OF-SERVICE SEPTIC SYSTEM 01 DESTRUCTION UA !- <br /> INSTALLATION WILL SERVE: A RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: I— NUMBER OF BEDROOMS: O;2 NUMBER OF EMPLOYEES: ^� <br /> SEPTIC TANK TYPE/MFG �Y7 /7�C1 /✓ CAPACITY �p�Q'� gal #OF COMPARTMENTS o� <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL Ry I,c ft FOUNDATION ft PROPERTY LINE 2C ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> Eli, 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 /> I MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> i 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 /> MINIMUM 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 <br /> SIGNED TITLE DATE �`�o��ZO <br /> RA.- <br /> Al./ C <br /> Op <br /> T <br /> DEPARTMENT U E ONLY <br /> Application Accepted B �- Z1, Date j as 20 Area �� Employee ID# DN <br /> Final Inspection By @a Date s ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil CCharacter: <br /> COMMENTS cfVe >7 CD13}!�► Y✓I Y► ells}1� job. <br /> �8 c,c C t7 1 i w L4 vn c>L.� <br /> (200 a��o <br /> PE SC Received Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO By Cash Remitted Service Re u st# <br /> `d ao l 05- <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />