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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 v / CITY/ZIP S U <br /> CROSS STREET %p /� f APN O 9 3C)9 37 PARCEL SIZE p <br /> � o <br /> OWNER NAME I PHONE C� l3 <br /> OWNER ADDRESS O P VX 1 CITY/STATE/ZIP ��I�e� J(� IVIG e7S(l <br /> CONTRACTOR / Vii/lam/ S �/ ' ,/i_ til; PHONE ��� z J 9/4/ <br /> CONTRACTOR ADDRESS ,� f /i��l Ii CITY/STATE/ZIP <br /> J <br /> ` <br /> LICENSE ❑DC-42 ❑FIC-36 OTHER NUMBER 2 EXPIRATION DATE <br /> WATER TABLE DEPTH:—_IyJJ ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# P D LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION _ ENGINEER DESIGNED/ALTERNATIVE <br /> C REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM L DESTRUCTION <br /> INSTALLATION WILL SERVE: ESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> �,�r" NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: ! NUMBER OF EMPLOYEES: �7 <br /> ,teSEPTIC TANK TYPE/MFG l CAPACITY gal #OF COMPARTMENTS Ci <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE 7 ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES LEACHING CHAMBERS #OF LINES j—� LENGTH OF LINES S ) ft <br /> DISTANCE TO NEAREST WELL J -Z. 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 _S WIDTH Y > ft DEPTH ,5 ) ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ��J! ft PROPERTY LINE ft <br /> 1 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 /> MIN/ 48 HOUR D-VANCFzNOTICE REQUIRED FOR INSPEC <br /> T <br /> IONS - PLEASE CALL 20 953-7697/ <br /> SIGNED TITLE DATE <br /> z, <br /> /h TWPA <br /> T <br /> �RVC0 <br /> P A <br /> T <br /> DEPARTMENT-USE ONLY <br /> Application Accepted By Date A; ;2 a-2_D Area % `1 Employee ID# 1� <br /> Final Inspection By Date ��Z`f�� ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Pit/Sump Soil Character: <br /> COMMENTS VJ SFR, ,FY '51-T <br /> PE SC Received ec Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO B Cash Remitted Service Request# <br /> Na i 117 sg 1 _20 � 00 <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />