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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 I YEAR FROM DATE ISSUED <br /> JOB ADDRESS <br /> CITYIZIP� <br /> �' /' <br /> CROSS STREET �T�1 i� =-�—_-- APN ��77Ii VO 6 Z- PARCEL SIZE �• '� <br /> tv <br /> OWNER NAMEEDPHONE ,l <br /> OWNER ADDRESS ��� �- (-11 CITY/STATE/ZIP d7ii . <br /> CONTRACTOR L[ Yi k, PHONE �CONTRACTOR ADDRESS .7 / r 711 <br /> .��f k 6/ CITY/STATE/ZIP <br /> LICENSE ❑f42 ❑❑C-36 OTHER NUMBER Q47r7 EXPIRATION DATE <br /> WATER TABLES DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# Z_LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION El REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ OUT-OF-SERVICE SEPTIC SYSTEM ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE El COMMERCIAL ❑ OTHER <br /> 1/ NUMBER OF LIVING UNITS: I NUMBER OF BEDROOMS: 3__ �" NUMBER OF EMPLOYEES: <br /> l� SEPTIC TANK TYPE/MFG r� °-e CAPACITY /cA90 gal #OF COMPARTMENTS <br /> '/►pJ� GREASE TRAF TYPE/MFG 10 CAPACITY gal #OF COMPARTMENTS. <br /> 6 <br /> DISTANCE TO NEAREST: WELL /Q� ft FOUNDATION /Q ft PROPERTY LINE 3® ft <br /> LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> yLEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES „ ft <br /> DISTANCE TO NEAREST WELL /®0'0 ft FOUNDATION /O A ft PROPERTY LINE r ft <br /> IJ 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 /> LyT, SEEPAGE PITS NUMBER 3 WIDTH�y� 414'j ft DEPTH rl�� ft <br /> DISTANCE TO NEAREST WELL 0 ft FOUNDATION ft PROPERTY LINE Ale 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 /> MINIMUM 48 HOUR ADVANCE- NOTICE REUIRED FOR INSPECTIONS- PLEASE MALL2( 09, 953-7697 <br /> 4 /- -���_ <br /> SIGNED �� TITLE G�r �I DATE "' <br /> ftv <br /> N N <br /> T <br /> T <br /> DEPARTMENTUSEONLY <br /> Application Accepted.By Date 7,0 Area Employee ID#� <br /> Final Inspection By Date Zig c9, ❑ SPECIAL ERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: r Pit/Sump Soil Character: -S R+J� <br /> CO M M E NTS �Al&,hfi__ A-C „-'Q 2 6 0 S(I Y'7 K _ —4la- a�,& xf�, Z 1Mj21. <br /> PE SC Received hec Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO B Cash Remitted Service Request## <br /> Z4 I _1 <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />