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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 c f CALL 209 953-7697 FOR INSPECTIONS 'l 9--EXPIRES 'I YEAR FROM DATE ISSUED <br /> JOB ADDRESS S V I CITYIZIP 44 k o&te— 1--,4- <br /> .j <br /> 7 m <br /> CROSS STREET .)�Sj`L �- APN �� ��Q'� /'-7 PARCEL SIZE y <br /> v <br /> J v <br /> OWNER NAME Lutz J�mC�, 1 17 PHONE <br /> OWNER ADDRESS 'J;2 S Siff CITY/STATE/ZIP ��IJ/� iVt'V y7?t CA 9,536,1-;, n <br /> CONTRACTOR jM l L��Gc_F L.7� �—{� PHONE <br /> CONTRACTOR ADDRESS 8) sm CITY/STATE/ZIP <br /> LICENSE ❑I C-42 1111C-36 OTHER NUMBER(20&251�EXPIRATION DATE <br /> G� i <br /> WATER TABLE DEPTH: q`-' ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# )S )Gi J`f J % LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION l ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM 11 DESTRUCTION <br /> INSTALLATION WILL SERVE: V---'RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> LI,--'SEPTIC <br /> , NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: �3 NUMBER OF EMPLOYEES: <br /> W/JtPTIC TANK TYPE/MFG CAPACITY L� f� gal #OF COMPARTMENTS Z <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL I per_ ft FOUNDATION�3�j, ft PROPERTY LINE 7 <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> Ce LEACH LINES LEACHING CHAMBERS #OF LINES� LENGTH OF LINES S5 I ft <br /> ft <br /> DISTANCE TO NEAREST WELLFOUNDATION 4j 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 3 WIDTH �6 ft DEPTH XS ft <br /> DISTANCE TO NEAREST WELL t 44 ft FOUNDATION L � —ft PROPERTY LINE �b�� 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 A V CENO-TI E RE UIRED FOR INSPECTIONS -PLEASE CALL 209 953-7697 <br /> SIGNED TITLE (C 14-0' DATE ao <br /> UI <br /> LT .111VAICA T <br /> T <br /> J DEPARTMENT USE ONLY <br /> Application Accepted By `� Date �7 �; v�J D Area �`7 Employee ID# 5 <br /> Final Inspection By eDate n' C SPECIAL PERMIT-Approved by <br /> 'er <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS fe, <br /> PE SC ReceivedC—gftgAmount Date Permit/ Invoice# Permit ID# <br /> Code INFO B ash Remitted Service Request# <br /> �Idi 117 / 9 s� 1X120 54t�o� <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/16 <br />