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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.H/SELTON AVENUE-STOCKTON CA 95205-(209)4683420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS ZScI o I iJ faf2►ti'1 A N p4z, • CmY/ZIP f'C ITM Po `lS 2,ZD a <br /> CaC"l.l - APN 0Z1 S r PARCEL SIZE <br /> /�G• > <br /> CROSS STREET T,, 32-7 <br /> _ G 4 ° <br /> OWNER NAM I�l3o?-A-i) W AFa�- LAZO m^Ey PHONE 3 2-7' S 3 6 I �n <br /> OWNER ADDRESS S/I 1"C CrrY/STATE/ZIP <br /> PHONE 3(a9 <br /> CONTRACTOR �jtty�e 4rC6'EN Vb12C��E7� L- 03� <br /> CONTRACTOR ADDRESS �o-� W. 0 P<V- ST• CITY/STATEIZIP L cj->( <br /> UcENSE ❑❑C-42 13❑C36 OTHER G FCs- NUMBER 7-15-1 EXPIRATION DATE f-3 0'-ZZ <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X — Y <br /> 1K PERC TEST # I BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADornoN ❑ ENGIN EEFI DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ OUT-OF-SERVICE SEPTIC SYSTEM ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER_ <br /> NUMBER OF LNING UNITS' NUMBER OF BEDROOMS: NUMBER OF EAIPLOYEES: <br /> ❑ SEPTICTANK TYPEIMFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASETRAP TYPEIMFG CAPACITY gal #OFCOMPARTMENTS <br /> DISTANCE TO NEAREST: WELLft FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP O PKG TX PLANT O SAND OIL SEPAFVTOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES Y <br /> DISTANCE To NEAREST WELL It FOUNDATION ft PROPERTYUNE <br /> C3FILTER BED WIDTH ft LENGTH ft DEPTH_ CFS <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft r AFD <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH— n <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY UNE <br /> ❑ SUMPS WIDTH ft LENGTH It DEPTH SAN i..�ftt <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE n`� CO <br /> O DISPOSAL PONDS WIDTH ft LENGTH ft OSTM— 4J6 q n' <br /> DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE MFNT <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH— ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> I HEREBY CERTIFY THAT I HAVE PREPARED <br /> THIS <br /> LAWS AND RULES AND REGULATIONS DONE SAN N ALCORAQUIN DANCE COUNTY. SAN JOA.QUIN COUNTY ORDINANCES, <br /> MINIMUM 48 R ADV N 1 E REQUIRED FOR IN PECT/ NS-PLEASE CALL(209)953-7697 <br /> / <br /> SIGNED TITLE �2OJ. AMC�FZ DATE �- Z(n-LO <br /> T17=IL <br /> 1� DEPARTMENT USE ONLY1a <br /> Application Accepted By Date Area Area q/« Employee ID# J/'l <br /> Final Inspection By Date ❑ SPECIAL PERMIT•Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS <br /> PE SC Received h Amount Permit/ Invoioz# Permit ID# <br /> Code INFO B Cash Remitted Date Service Request# <br /> H. d sa 1 S z U' <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />