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J <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`--��1yn ICITY/ZIP <br /> CROSS STREET APN I I 1 Jy O PARCEL SIZE a <br /> OWNER NAME / ' ) 4 l 1"Y�" -�N ✓ PHONE <br /> OWNER ADDRESS I'"f � ( 4 r�kJl—1 CITY/STATE/ZIP V Ay,/AL'L— J�uo <br /> CONTRACTOR Central Valley Demolition Inc PHONE 209-450-6432 <br /> CONTRACTOR ADDRESS 3928 Crocus Drive CITY/STATE/ZIP Modesto,CA 95356 <br /> LICENSE L C-42 L :C-36 OTHER C-21 NUMBER 901159 EXPIRATION DATE 07/31/2017 <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> L PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION REPAIRIADDITION ENGINEER DESIGN �I�7ERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM x DESTRUCTIONL%1' �C.. <br /> INSTALLATION WILL SERVE: L RESIDENCE L COMMERCIAL L' OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPEIMFG 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 /> ❑ FILTERBED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION fl 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 fl DEPTH ft <br /> DISTANCE TO NEAREST WELL fl 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 24 HO ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-76 7 <br /> SIGNED TITLE Contractor DATE <br /> MENT <br /> EIVED <br /> 5 2020 <br /> UIN COUNTY <br /> ?CINMENTAL <br /> DEPARTMENT <br /> DEPARTMENTUS ONLY <br /> Application Accepted By � Date S vd L' Area �L Employee ID# <br /> Final Inspection By Date U SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Chr,C.,ter: <br /> COMMENTS DF'Vl7 D� 10(1 16JL4 SCS CtV� el(�k 0" e c1 A S <br /> r <br /> PE SC ceived t ate Permit/ Invoice# Permit ID# <br /> Code INFO ml ted Service Re uest# <br /> L4031 07� • <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/24/12 <br />