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1� <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 <br /> NON-REFUNDABL PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS o CITY/ZIP `te <br /> 7 .rl <br /> a <br /> CROSS STREET LGs� IVPS �� APN 0? 79n� y ��3 PARCELSIZE 1 q b <br /> OWNER NAME � /U If D PHONE <br /> OWNER ADDRESS CITY/STATE/ZIP <br /> CONTRACTOR IC �� L / PHONE -s' <br /> v / n <br /> CONTRACTOR ADDRESS —/ C� ✓. CL✓ �//�— CITY/STATE/ZIP 4'z. CSS "7_f 2fJ <br /> LICENSE ❑CiC-42 ❑❑C-36 OTHER NUMBER Jl-S W3 EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT I# LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATIONREPAIR/ADDITION El ENGINEER DESIGNED I LTERNATIVE <br /> L REPLACEMENT 'f C;1 , 11 Q�j D OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION JCSV1k'_ <br /> INSTALLATION WILL SERVE: 1 RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: � NUMB/ER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> SEPTIC TANK TYPE/MFG / <br /> 6" C�7 vim%/�� CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> 1 <br /> DISTANCE TO NEAREST: WELL /� � ft FOUNDATION ft PROPERTY LINE —r-D, ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> L�1 LEACH LINES 17, LEACHING CHAMBERSQ 3� #OF LINES LENGTH OF LINES �`� ft <br /> DISTANCE TO NEAREST WELL,/ 90 ft FOUNDATION Z274 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 /> MINIMUM 4eHOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS`-- PLEASE CALL (209) 953-7697 <br /> SIGNED TITLE DATE 2 <br /> A JOAO it f d JNTV <br /> E 'RANA F_ :.71H `' ,2 <br /> P R 1,A .4Z <br /> 1 11 <br /> T <br /> O <br /> O <br /> Fp Tq <br /> T <br /> DEPARTMENT U E ONLY <br /> Application Accepted By ��G Date S LLo Area `7 �G Employee ID# <br /> Final Inspection By Date_ 2 2c?" PECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Ch racter: <br /> COMMENTS Endy> , or kink 2 1e C- j6; �C e <br /> /d <br /> !, S 6 be <br /> PE SC Received heclk#A Amount Date P nr it/ Invoice# Permit ID# <br /> Code INFO B Remitted Service Re nest# <br /> 42-01 ��L ad "' ""�`� v� � ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />