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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 EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS —CITY/ZIPTL'Ib>� <br /> JC <br /> OWNER <br /> n <br /> CROSS STREET r i Il//I�e APN 0Op�d5�q PARCEL SIZE �' o <br /> OWNER NAME O f 7 P'C-G� /.J i C } SVA h I PHONE 'A <br /> OWNER ADDRESS SG;W!e- CITY/STATE/ZIP 7y <br /> CONTRACTOR_ 1 �y �13 4dtt—fin//,s T�-� �1 PHONE Lj__t `,ykL S <br /> CONTRACTOR ADDRESS CITY/STATE/ZIP 1�V��G�—►BYE ,A- ( 64 ' ,�73(j <br /> LICENSE ❑LJC-42 ❑LIC-36 OTHER _ NUMBER —EXPIRATION DATE_{g) <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: i I NEW INSTALLATION REPAIR/ADDITION I I ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM L1 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 -1 LEACHING CHAMBERS #OF LINES�_ LENGTH OF LINES 14,') _ ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION PS ( ft PROPERTY LINE �S 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 /> 01�SEEPAGE PITS NUMBER WIDTH 334 ft DEPTHS I ft <br /> ,I` <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 U01,IR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 <br /> SIGNED TITLE /V C C*C I' DATE <br /> VA <br /> DEPARTMENT USE ONLY I ll� HEALTH DEPARTI�EI+f'r <br /> Application Accepted By ��^ Date 7 7 �r�0 Area -I Employee ID# dJ�i <br /> Final Inspection By Date ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Deth of 3 Ft: PiVSump Soil Character: <br /> COMMENTS `�„ru-"e -�er,2 0;'� e:►'Isj'Lj <br /> PE SC Received heck Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO By sh Remitted Service Request# <br /> a I O HS- GJ i 3 00 -1-2,7.2 W 23310 <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />