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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 c ExPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS II t! CITY/ZIP _540al�. ol- <br /> CROSS STREET ` ' / APN R 13 U3 O PARCEL SIZE C2C <br /> ZAPM <br /> OWNER NAME by /�7 1 PHLONE <br /> OWNER ADDRESS Fy .9 0'r �+1'l a� // CITY/STATE/ZIP s-f ^4 N 1 Q <br /> S a I� <br /> CONTRACTOR 6' AI I 114 l� iN C_ PHONE 7,La%-/ 26"9--rc9 7 <br /> CONTRACTOR ADDRESS 37Y ;;", /�Q D✓ CITY/STATE/ZIP J'�( q fSa/;` <br /> LICENSE ❑'(42 111-IC-36 OTHER NUMBERl`/a5�?- EXPIRATION DATE w 3o/a <br /> WATER TABLE DEPTH: 5��60 ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION I ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM Ll DESTRUCTION <br /> INSTALLATION WILL SERVE: Ix RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: y NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> El �7/SEPTIC TANK TYPE/MFG L 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 I LEACHING CHAMBERS #OF LINES_!I& LENGTH OF LINES_1/0 ft <br /> I* <br /> DISTANCE TO NEAREST WELL /!�y ft FOUNDATION 0 ft PROPERTY LINE U ' 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 It ft <br /> PROPERTY LINE <br /> I <br /> SEEPAGE PITS NUMBER / WIDTH _7' ft DEPTH ;zS ft <br /> DISTANCE TO NEAREST WELL �� ft FOUNDATION 100 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 /���Z . // TITLE CSN�1+�7L� DATE 17- <br /> Vil <br /> EA <br /> Q d1h C <br /> Ro <br /> E T NAL <br /> DEPARTMENT U E ONLY NT <br /> Application Accepted ByC�� Date 7 Oo7zQ Area ! Employee ID# ��� <br /> Final Inspection By Date _ /-4 /oL020 ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to DefItINAf 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS P�pC.5 Col DSecj• ) !FY . <br /> PE SC ReceivedChec JFRemitted <br /> Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO B sh Service Request# <br /> 4910 1►s �0 <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />