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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1668 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)466-3420 <br /> NON-REFUNDABLE PERMIT <br /> CALL(209)953-7697 INSPECTIONS EXPIRES1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 7-4L-zZ A • SA-bLL(2`fT -%JCr ka, CITY2P A-C-^-VKPD `572.10 <br /> � <br /> y <br /> CROSS STREET Lt90r0�'f Ja APN 0 0V--'3(P�"I r PARCEL SIZE Z ' Av- <br /> O <br /> 0O <br /> OWNER NAME �X00y �_CAPCJA A0 <br /> OWNER ADDRESS Sr'r•C CITY/STATE/ZIP <br /> CONTRACTOR LIJt_ Vim' CrCOCt•,�-d.vr�'tl6n/Tt_ PHONE 3tact ' a3�1� A <br /> CONTRACTOR ADDRESS �C� Q , i CITY/STATE/ZIP LO� 01 <br /> LICENSE L. C-42 11]:C-36 OTHERT NUMBER ZI�( EXPIRATION DATE `3V _'L <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM : 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 If FOUNDATION It PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES 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 It DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE If <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH It <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE It <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 It DEPTH ft <br /> DISTANCE To NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It <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 ADVA E NOTICE E /RED FOR INSPECTIONS-PLEASE CALL 2 953-7697 <br /> SIGNED TITLE p `J ' 6� DATE `M -Z� <br /> A rip <br /> ( <br /> EIV <br /> i <br /> �D <br /> No 2020 <br /> v CoUN <br /> I1 ENT,4L <br /> RTIyENT <br /> DEPA RTMENT+USE ONLY <br /> Application Accepted Sy z"/ Date OcX o Area �C Employee ID# DA <br /> Final Inspection By - Data -„/S)-14) E SPECIAL PERMIT-Approved by <br /> Character of Soil t epth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS <br /> PE SC Received heck#/ Amount Permit/Code INFO B Remitted I SoDate rvi Re u st# Invoice# Permit ID# <br /> '-Dda Sa3 isw <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />