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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-REFUNDABLEPERMITCALL(209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS V-I 'EI CITY/ZIP I J rZ <br /> CROSS STREET & APN PARCEL SIZE <br /> OWNER NAME , OZ PHONE <br /> Aj <br /> OWNER ADDRESS �676 CITY/STATE/ZIP <br /> CONTRACTOR ` PHONE ! 'V r �/ <br /> CONTRACTOR ADDRESS fYn1.� CITY/STATE/ZIP LW . e,.* I J D <br /> LICENSE 1:1! C-42 ❑I IC-36 OTHERNUMBER _EXPIRATION DATE I11 <br /> WATER TABLE DEPTH: ft/ GEOGRAPHICAL INFORMATION: Coordinates X '7Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: I NEW INSTALLATION I REPAIR/ADDITIONENGINEER DESIGNED/ALTERNATIVE <br /> I REPLACEMENT I OUT-OF-SERVICE SEPTIC SYSTEM y DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> SEPTIC TANK TYPE/MFG 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 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 /> ❑ 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 /> MINIMVIV48 H8UR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL 209 953-7697 <br /> SIGNED TITLE DATE`7-I-Z-PZ0 <br /> DEPARTMENT USE ONLY <br /> Application Accepted B l�"`C— Date 7 d 030 Area Eiry�o����e//ID# DA <br /> Final Inspection B <br /> Date ❑ SPE IA–� IT (+r'o�ti� Wr <br /> P Y <br /> Character of Soil to D of 3 Ft: Pit/Sump Soil Character: EC'U f V rU <br /> COMMENTS �L <br /> 2020 <br /> SANOgQUIN C <br /> PE SC Received Check#/ Amount Date Permit/ Invoice#TH pAR7r ID# <br /> Code INFO B Cash Remitted Service Request# <br /> q)d I 07S1 S� 7 <br /> 42-01 I l O{� ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />