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04 <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 /> 31 <br /> JOB ADDRESS N 'Deus i-e S CITY/ZIP W I 95a n <br /> / -1 <br /> CROSS STREET pel V, f � APN O Ssa 3�0 a1 PARCEL SIZE <br /> ', <br /> z <br /> OWNER NAME PHONE <br /> OWNER ADDRESS LAI <br /> /J �nL CITY/STATE/ZIP <br /> CONTRACTOR f�(// 7,v <br /> 7 ALAI l/�/ SCJ/��/o1�C PHONE �y � s�a/7 <br /> CONTRACTOR ADDRESS / ` & '� �""' �� ��" CITY/STATE/ZIP -` �"n C-4— <br /> LICENSE 114-42 ❑CIC-36 OTHER NUMBER `7S7:07CEXPIRATION DATE <br /> WATER TABLE DEPTH: 3 t7 ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: LI NEW INSTALLATION REPAI ADDITIO LI ENGINEER DESIGNED/ALTERNATIVE <br /> X REPLACEMENT f4 kik ❑ OUT-OF- ERVICE SEPTIC SYSTEM X DESTRUCTION ew K <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: 0 NUMBER OF EMPLOYEES: <br /> r <br /> X SEPTIC TANK TYPE/MFG /O�lC1� CAPACITY !oRnO gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ( 'F ft FOUNDATION ft PROPERTY LINE f0 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 �D ft <br /> DISTANCE TO NEAREST WELL I ft rFOUNDATION rb ft PROPERTY LINE ft <br /> FILTER BED WIDTH =fe ft LENGTH_ j-&- ft DEPTH --491- ft <br /> DISTANCE TO NEAREST WELL /a6 ft FOUNDATION l� ` ft PROPERTY LINE O�5 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 WIDTH ft DEPTH ft <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 /> MINIMUM 448 HOUR ADVANC/E�. NOTICE REQUIRED FOR INSPECTIONS- PLEASE CALL�209)953-7697 <br /> SIGNED "/�c.�C �+.� �/_ TITLE �'lk46jk DATE <br /> IE <br /> N JO Q IN Cc UN <br /> EMMMEN AL <br /> DEPARTMENT U E ONLY DA <br /> Application Accepted By T Date OHO Area 4 y�'� Employee ID# <br /> Final Inspection By ( Date_ ) - ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of/3 Ft: It/Sump Soil Character: <br /> COMMENTSeS� In cz ld !P 144in ' tPPIW /I ^, F; Err ,- J0� <br /> I n . <br /> PE SC Received Check#/ Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO Ca Remitted S rvice Reque t# <br /> bra yrs 3 ZU <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />