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b <br /> )NSI VASTEWATER TREATMENT SYSTEM PERWT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 <br /> KION-REFUND ERM CAL (209)953-7697 FOR INSPECTIONS BXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS ckdc ( F CITY/ZIP <br /> CROSS STREET (`may/�U e( APN 0S)y'?03 S PARCEL SIZE <br /> OWNER NAME �1 v vCF/ �/► P/Hl0N5�15f- <br /> CITY/STATE/ZIP <br /> r �[ S /�G� <br /> OWNER ADDRESS �V �' ��� / CITY/STATE/ZIP �d`� �r L ✓ `y <br /> 97 <br /> CONTRACTOR 4A, J d 1(eX 1(e 41 44 PHONE �U ( �C� ` J <br /> . /f. <br /> CONTRACTOR ADDRESS S d ti / <br /> C CITY/STATE/ZIP / �' C..-� ( J <br /> LICENSE ❑LIC-42 11IJC-36 OTHER4 /NUMBER 62yy_ n <br /> EXPIRATION DATE l^31 a/ <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: C NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/ LTERNATIVE <br /> ❑ REPLACEMENT n OUT-OF-SERVICE SEPTIC SYSTEM ,'DESTRUCTION fQnj< <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> M SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> 13 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 /> 0 LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTYLINE. ft <br /> E] FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> G?1 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 /> D DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> �J SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE'ro 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 /> M&MUM 4 HOWR ACD4rAIVCC NOTICE REQUIRED FOR INSPECTIONS -PLEASE CALL 209 953-77697 <br /> SIGNED TITLE C� �'G DATE <br /> lu <br /> E O N <br /> H E L <br /> DEPARTMENT U E ONL1' <br /> Application Accepte y G� Date 6 d aoa0 Area �I� Employee IN D7"t <br /> Final Inspection By Date1 � ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS .,Iain eir ote cdieheol <br /> T' <br /> PE SC ReceivedChecic# Amount Permit/ <br /> Code INFO By ash Remitted Date Service Request# Invoice# Permit ID# <br /> `iaa l ass �7 � ►sa ?D � � <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />