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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 209 953-7697 FOR INSPECTIONS EXPIRES'I YEAR FROM DATE ISSUED <br /> JOB ADDRESS * t'Zs(/ � Jt CITY/ZIP T• &rC <br /> CROSS STREET �y1��WR N APN I O �O� PARCEL SIZE�� y <br /> G <br /> OWNER NAME JOy\n <br /> SPHONE <br /> HONE <br /> o <br /> -9-(,V2` v <br /> K. <br /> OWNER ADDRESS Jn 0 CITY/STATE/ZIP <br /> CONTRACTOR &113l1 -loc . <br /> PHONE 703 GlY6 <br /> ^7ZS <br /> CONTRACTOR ADDRESS I I �Irk2 (J( CITY/STATEIZIP G✓-i <br /> LICENSE ❑'. C-42 ❑NC-36 OTHER NUMBER9'�WZC�7 1 EXPIRATION DATE �� I <br /> WATER TABLE DEPTH: I V J' ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> E PERC TEST # BUILDING PERMIT# 70'133? LAND USE APPLICATION# <br /> TYPE OF WORK: a NEW INSTALLATION REPAIR/ADDITION i ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM i I DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: I NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> lit SEPTIC TANK TYPE/MFG CAPACITY 20e-�.n gal #OF COMPARTMENTS z <br /> ❑ GREASE TRAP TYPE/MFG {{ {� CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL N T ft FOUNDATION LU ft PROPERTY LINE �� ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT 7 ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES LEACHING CHAMBERS LQO� #OF LINES J LENGTH OF LINES ��/ ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION I ft PROPERTY LINE �'n 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 /> ❑ SEEPAGE PITS NUMBER J WIDTH Ul' ft DEPTH <br /> ZS ft <br /> DISTANCE TO NEAREST WELL N A ft FOUNDATION i O ft PROPERTY LINE �ll 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 /> M1 M 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 <br /> SIGNED TITLE / a4n DATE G -LOZy <br /> r --IL <br /> -� <br /> SAA J <br /> Z vR N <br /> R <br /> it <br /> i <br /> > > Bwu <br /> ONLY //Application Accepted By Date ���d Area J Employee ID# �/�_Final Inspection By — 27w Date i� ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS /yP0 SFR- )`,'P( C'Dn 'Put'J" /)o v.lel S 'n Ko pe/ <br /> PE Sc Received hec Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO ash Remitted Service Request# <br /> q'q �►7 �5"8`j2) Zu <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />