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1 � <br /> c <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-REFUNDABLE PERMIT CALL(209) 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS L I + CITY/ZIPLj <br /> CROSS STREET ,'i 1 /APN lJD C� 4 PARCEL SIZE " /✓ o <br /> n � ' 0 <br /> OWNER NAME J;� jy/ �, PHONE 20 :j-5(�y�T/,lmay/G� /(rJv� <br /> OWNER ADDRESS [ ( l L am/ / /t,� �(^t� CITY/STATE/ZIP j r�((J/l C <br /> CONTRACTOR ( �[�i�]�J�C.[I[- .r� I�tc, PAM( �� HONE <br /> CONTRACTOR ADDRESS S5 !y. LIt }AiW!^y/,r -DR <br /> L rCITY/STATE/ZIP <br /> ❑LC- 2 C-36 OTHER lj 7 EXPIRATION DATELICENSE NUMBER �� � / <br /> C�('- �� <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# i LAND USE APPLICATION# <br /> TYPE OF WORK: C NEW INSTALLATION REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT fl 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 �� yte) CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP I ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> Id LEACH LINES a LEACHING CHAMBERS �^� � #OF LINES � � LENGTH OF LINES �D ft <br /> DISTANCE TO NEAREST WELL r ft FOUNDATION (f. ft PROPERTY LINE �j r 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 /> ,b, SEEPAGE PITS NUMBER <br /> WIDTH `�( �� ft DEPTH 2 'Z:Ej r ft <br /> DISTANCE TO NEAREST WELL I00f 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 /> M U '48 ADVANCE NOTICE REQUIRED FOR INSPECTIONS -PLEASE CALL 209 953-7697 <br /> SIGNED / TITLE + (�� �y DATE M- ,22--Z <br /> Aj <br /> A <br /> 71 1 <br /> N <br /> EPARTMENT USE ONLY <br /> Application Acceptedy Date Area Employee ID# '<ut <br /> Final Inspection By Date © [ISPECIAL PERMIT-Approved by <br /> Character of Soil tot of 3' Pit]Sump Soil Character: S S <br /> COMMENTS ; X'0 rrO t <br /> PE Sc Received Check#/ Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO By Cash Remitte Service Request# <br /> Z 1t I 3 - 5-2pt lhOSIZ <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />