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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-(REFUNDAB <br /> L <br /> E <br /> PERMIT / CALL 209 953-7697 FOR INSPECTIONS /� EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS (p G t t7/JP CITY/ZIP Ae4;�O Igm <br /> �+ 03 35 <br /> �/ APN n I� PARCEL SIZE c I Y <br /> CROSS STREET 4 C <br /> OWNER NAME ///id ////'�/Z/�J�' PHONE <br /> OWNER ADDRESS n 144�h 0 CITY/STATE/ZIP <br /> CONTRACTOR GrG.� �L�]//9�/Gi �C®y�yt�'� PHONE �� <br /> CONTRACTOR ADDRESS CITY/STATE/ZIP <br /> LICENSE ❑b-42 Ell-IC-36 OTHER NUMBER ySSYJ�S EXPIRATION DATE O <br /> WATER TABLE DEPTH: C' ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: 11 NEW INSTALLATION Cpe- REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT �kt N k I. OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION k <br /> INSTALLATION WILL SERVE: k� RESIDENCE ❑ COMMERCIAL 7 Q�� .f�,u [I OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: J 410I 016 NUMBER OF EMPLOYEES: -7 <br /> SEPTIC TANK TYPE/MFG G3//22 " I'� `�' ri16y' CAPACITY �Iee— gal #OFCOMPARTMENTS <br /> ❑` GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFT STATION $IZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES CI LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL 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 /> � <br /> ,/' a <br /> SUMPS WIDTH V / �ft LENGTH ft DEPTH Ly r ft <br /> DISTANCE TO NEAREST WELL e 5 ' ft FOUNDATION �O , 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 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS -PLEASE CALL 209 953-7697 <br /> SIGNED TITLE DATE y r& <br /> L <br /> y <br /> 'F u TY <br /> NWRONMENTAL <br /> 1Q, iE kL H DEPARTMENT <br /> T � <br /> 9 <br /> >r. <br /> / DEPARTMENT USE ONLY <br /> Application Accepted By C z!�— Date /g d,3do Area Employee ID# D� <br /> Final Inspection By t—d� Date 9 1 —kve SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS <br /> )ecith line. temk AZe n I gplAt d r p loonlqore C,A I 0102,n7lD <br /> PE SC Received Check#/ Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO B Cash Remitted Service Request# <br /> Llai rls' 3vi� <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />