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3 <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 C LL 209//)``953-766 7 FOR <br /> .'INSPECTIONS <br /> -} EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS I�- —PC,05g, R4 �� 2y ISI van, JOlk I �TY/ZIP ),r4 <br /> , I ( 1 H <br /> CROSS STREET -449 �/d�'t JvS 1 e APN �-3(j7n PARCEL SIZE <br /> OWNER NAME Lues L' r cPHONE <br /> OWNER ADDRESS V o r► SOS- yl /<<� CITYISTATE/ZIP <br /> CONTRACTOR y y l t�-( r� GCC h�Z ��( PHONE ` ''l� 84-- <br /> CONTRACTOR ADDRESS 'PO C7 Y (/ ! t, CITY/STATE/ZIP <br /> LICENSE ❑LIC-42 ❑LIC-36 OTHER ] NUMBER(0 a�7� T EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT#BP-.100 I 2 LAND USE APPLICATION#,~ <br /> TYPE OF WORK: NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> D REPLACEMENT n OUT-OF-SERVICE SEPTIC SYSTEM ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: dYRESIDENCE ❑ COMMER IAL ❑ OTHER <br /> � NUMBER OF LIVING UNITS: i NUMBER OF BEDROOMS: / NUMBER OF EMPLOYEES: <br /> Li/ Q <br /> SEPTIC TANK TYPE/MFG f L L CAPACITY gal #OF COMPARTMENTS `� <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION 16 ft PROPERTY LINE 10 ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> O LEACH LINES ❑ LEACHING CHAMBERS #OF LINES_� LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ' 1)0 It- ft FOUNDATION 161 ft PROPERTY LINE /C� 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 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)x953-7697 <br /> SIGNED TITLE DATE VJr <br /> jr <br /> ez <br /> O <br /> H O O N <br /> AR <br /> / DEPARTMENT USE ONLY <br /> Application Accepted B /�� Date 7_1D4',0 Area S Employee ID# SIC _ <br /> Final Inspection By Date 2020 ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: it/Sump Soil Character: <br /> COMMENTS New SFR. <br /> PE SC Received heck Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO By ash Remitted Service Request# <br /> Hail 117Sg`- • o S <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />