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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)1953-7697 FOR INSPECTIONS EXPIRES 1pYEAR FROM DATE ISSUED <br /> JOB ADDRESS I4 L4 -I I p L�u-I er-w— 9--b CITY/ZIP A-r—A-m PD <br /> CROSS STREET FV rtrt MrYnJ APN 02-1 .. JV icy PARCEL SIZE 4-Tce A "• <br /> n�;� 0 <br /> OWNERNAME IAFA� ^l�AVA'R-e2PHONE 411) - /eLZ3 <br /> OWNER ADDRESS � (o � CITY/STATE/ZIP Af-A-Wn0 <br /> C-M 15-2-2-00 <br /> CONTRACTOR L•ILIP- OA <br /> PHONE 3tygI `o37, <br /> CONTRACTOR ADDRESS 4o-7 <br /> w' OAK Sr• CITY/STATE/ZIP f. ( CA y r 2-4 CD <br /> LICENSE E C-42 ❑.0-36 OTHER �� NUMBER Z 1 r1 EXPIRATION DATE 3 L2- <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 ft FOUNDATION ft 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 It LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH It <br /> DISTANCE TO NEAREST WELL ft 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 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 /> M1N1MUW§!H0UR ADVANCE T/ E REQUIRED FOR INSPECTIONS-PLEASE CALL 2953-769 <br /> SIGNED TITLE M V/2• DATE -7`2-1-2.0 <br /> PAY�FNT <br /> ECE/Viet) <br /> 3 0 ?020IN <br /> ,RONUN1Y <br /> Cp <br /> HEPAR VENT <br /> z- LLDEPARTMENT-USE <br /> ONLY <br /> Application AcceptDate <br /> Area Employee ID# A <br /> Final Inspection By �' ~ <br /> _ <br /> 11 Date rh 7 � L� L O ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS L fl ✓� 1 <br /> V 1,= Aa,ow fF jA, 42 L4,e2 io n. <br /> PE SC Received Check#/ Amount Date Permit/ Invoice# PermitID# <br /> Code INFO By Cash Remitted Service Re est# <br /> ,daa s 23 -L-1-30Z 5 <br /> 42-01 �#/ I I '/ / l ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 `P 1 <br />