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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 PE MIT _ CALL(209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED Ch <br /> JOB ADDRESS l n ,pp� QQ—CITY/ZIP AYE /Cy � <br /> CROSS STREET ('L/_e-s! !�\l �I /KJ APN O /� EZ4 PARCEL SIZE <br /> d <br /> OWNER NAME 8i'A f0sh , �, t rG l Ytf`IS lC PHONE <br /> OWNER ADDRESS L 3 3 3 W TZ F c� CITY/STATE/ZIP it f D fj 4�4 �: (e 62 <br /> CONTRACTORII�CJ 7C l� C�`� ./� `' PHONE <br /> CONTRACTOR ADDRESS �6 64) CITY/STATE/ZIP eiRt 1 <br /> LICENSE ❑0C-42 ❑LIC-36 OTHER NUMBER 6C6'_S" EXPIRATION DATE <br /> WATER TABLE DEPTH: S ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # i� BUILDING PERMIT# O LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> IJ REPLACEMENT ❑ OUT-OF-SERVICE SEPTIC SYSTEM ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: LJ IF ESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: I NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> 0/'SEPTIC TANK TYPE/MFG �ff I� CAPACITY D gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPEIMFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL I w"f ft FOUNDATION�25_ ft PROPERTY LINE S r ft <br /> L3 LIFTSTATION SIZE TYPE OF PU`M-P - ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEREST WELL ftry r FOUNDATION ft PROPERTY LINE _ ft <br /> FILTER BED WIDTH ft LENGTH b ft DEPTH 18", ft <br /> DISTANCE TO NEAREST WELL_t 501 ft FOUNDATION ��r ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> Cl 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 /> ❑ <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 /> R <br /> MINIMUM 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS- PLEASE CALL (209) 953-7697 <br /> SIGNED ( TITLE GtS1�) /IOt � DATE <br /> U <br /> P R r _ <br /> Ilk- YA HF PRA T <br /> J <br /> O U <br /> T <br /> J DEPARTMENT USE ONLY <br /> Application Accepted By —� Date x H755,5 Area 9% Employee ID# Sk <br /> Final Inspection By 11 Date 26 7"ot SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS evJ F r,'Pr C► 1-er be(-J yr6, V hP deeper n ya. ,QV�v�/ <br /> 6V ilec for r no/PG. r 1 -�✓fin f G� S - 6 l �°h . -F <br /> PE SC Received Chec Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO B ash Remitted Service Request# - <br /> Lia) In 8f s8 8• • 00 TZ 4 14 <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />