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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 YEAR FROM DATE ISSUED <br /> '-f <br /> JOB ADDRESS � dV �,�n'!P✓l/T'S� / CITY/ZIP <br /> CROSS STREET _Ikrn-'�-n/)p JaIz__ APIN _OCR3 LIDO)1 PARCEL SIZE Q / <br /> Ll C <br /> OWNER NAME �Ib / /{��J.(JIBS/ :Sc oll s4eVe PHONE m <br /> v <br /> OWNER ADDRESS <br /> /j,q d 1��i�Yl� C�I / CITY/STATE/ZIP /Lo( � `/J�y <br /> CONTRACTOR ��1� /- j �lle�, - L�_G'1J�jL PHONE_ <br /> CONTRACTOR ADDRESS __ 77 C// L� ?�i��c �/C CITY/STATE/ZIP <br /> LICENSE ❑i*.42 ❑LIC-36 OTHER NUMBER 7��/�y� EXPIRATION DATE 409V/ <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION tREPAIRIADDITION ENGINEER DESIGNED/ LTERNATIVE <br /> REPLACEMENT 0( 5y,-J'' OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: / NUMBER OF BEDROOMS: -3 NUMBER OF EMPLOYEES: <br /> �- SEPTIC TANK TYPE/MFG PL CAPACITY � �' gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION 0?0 ft PROPERTY LINE SOT ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT Cl SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES LEACHING CHAMBERS #OF LINES_3 LENGTH OF LINES SS ft <br /> DISTANCE TO NEAREST WELL ZCX" ft FOUNDATION 0, ft PROPERTY LINE j U 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 /> 2L. SEEPAGE PITS NUMBER 3 WIDTH ya ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ZSR ft FOUNDATION ft PROPERTY LINE It <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 /> MINI UM 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 <br /> SIGNED TITLEDATE <br /> via <br /> JL U <br /> IV <br /> JO <br /> 10 <br /> DE <br /> Pq T <br /> DEPARTMENT U E ONLY �? <br /> Application Accepte By Date .� D Area / Employee ID# DA <br /> Final Inspection By-%7' 1 Date ❑ SPECIALPERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: L Pit/Sump Soil Character: <br /> COMMENTS -)(54rW C,,,Jute, 7,Pr <br /> PE Sc Received Che Amount Permit/Code INFO B Cas Remitted Date Service Request# Invoice# Permit ID# <br /> aIo <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />