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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 1� YEARFROMDATE ISSUED <br /> JOB ADDRESS 1:/00 -7 /K( , CITY/ZIP �L•OL" �J To U' <br /> .�1!� 1, Q� .+�4� <br /> CROSS STREET ��c 'w 7 Aye APN L _r _ <br /> PARCEL SIZE ? <br /> �,] tvp <br /> OWNER NAME y J -A ) PHONE <br /> OWNER ADDRESS // U T r�11`J <� CITY/STATE/ZIP C�"� y <br /> CONTRACTOR � /� �-/� �le�'e/^1+ PHONE S 7 -y=Ljr3 <br /> J Imo` <br /> CONTRACTOR ADDRESS ' / �C/'/V �•l `J !/�' �j CITY/STATE/ZIP <br /> LICENSE ❑ C-42 ❑LIC-36 OTHER NUMBER-)/ /J.j EXPIRATION DATE <br /> WATER TABLE DEPTH: 7 ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: I I NEW INSTALLATION �AI 11REPAIR/ADDITION L�i ENGINEER DESIGNED/ALTERNAT VE <br /> jkT REPLACEMENT 40-10k n) CIV' 11 OUT-OF-SERVICE SEPTIC SYSTEM n, DESTRUCTION SE lIl- f <br /> INSTALLATION WILL SERVE: B RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: / NUMBER OF BEDROOMS: �: NUMBER OF EMPLOYEES: <br /> ® SEPTIC TANK TYPE/MFG CAPACITY `" gal #OF COMPARTMENTS z <br /> ❑ GREASE TRAP TYPE/MFG / CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE To NEAREST: WELL l `-�`� ft FOUNDATION S- ` ft PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES It' LEACHING CHAMBERS �� y �- #OF LINES 3 LENGTH OF LINES f`� ft <br /> DISTANCE TO NEAREST WELL O J ft FOUNDATION Ko 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 /> ❑ 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 /> 1 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 4,B HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS -PLEASE CALL (209)953-7697 <br /> SIGNED TITLE C�� '����/� DATE <br /> N� <br /> V1 p U <br /> D <br /> DEPARTMENT USE ONLY �1 <br /> 1 Em to <br /> Application Accepted By Date � Area ee ID#p y <br /> Final Inspection By K Date —_AJ '' ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS FadUle ,-f sy54ew. :f)'ey It, Maximum sud cover over chelmbes type SVs�rms )S <br /> PE SC Received (/—CheS_W Amount Permit/ <br /> Code INFO B ash Remitted Date Service Request# Invoice# Permit ID# <br /> yd)Q 119- <br /> 2 300 <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />