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ONSFE WASTEWATER TREATMENT SYSTEM f ERhfiiff <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)46B-3420 <br /> NON-REFUNDABLE PERMIT CALL 209) 953-7697 FOR INSPECTIONS/ EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 0 S I* 1y CITY/ZIP L ,t I q5 a4 s <br /> :i <br /> , )(7,7/ <br /> ! ty <br /> CROSS STREET I/WYI��f�/ V APN oy q la o J PARCEL SIZE )b,7/I �y <br /> R d. Ted <br /> OWNERNAME %V,PIhh�,WIQ1 !/ 1�ItII t-(Jy� i 1 �,aPHONE �0G-I� ' J{f�1� ,J✓ hYJCn <br /> OWNER ADDRESS V J CITY/STATE/ZIP Lb)i I <br /> CONTRACTOR 1 Q�{ I! YL ill 1 { Y_� PHONE <br /> CONTRACTOR ADDRESS Q ` CITY/STATEIZIP�w/ek <br /> -zl,�.Zz, 13,A�sg c 130120 <br /> LICENSE ❑LIC-42 ❑l_1C-36 OTHER NUMBE;9 194rl EXPIRATION DATE <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/ALTERNATIVE <br /> 11 REPLACEMENT FI OUT-OF-SERVICE SEPTIC SYSTEM P DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> 1 NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> 1� SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> C� GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> OO LIFT STATION SIZE TYPE OF PUMP 0 PKG TX PLANT ® SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> 13 LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> U FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> CQ MOUNDED WIDTH ft LENGTH_ ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> Q SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> 0 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,)9953-7697 <br /> SIGNED TITLE (I/- ffeA"fA.1 DATE <br /> DEPARTMENT VSjE ONLY <br /> Application AcceptAel <br /> z1/— Date 7 / oZ Area `� Employee D//� <br /> 1 <br /> Final Inspection By Date � / W7.0 ❑ SPECIAL PERMIT-Approve <br /> TA– <br /> Character of Soil to of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS <br /> N JUL <br /> JOAQUI <br /> MeXi <br /> PE SC Received Checic#/ Amount Permit/ M p <br /> Code INFO By Cash Remitted Date Service Request# Invoice# <br /> yaal ops .# �sa <br /> 4 :II /� 2/�O ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/141114/18 <br />