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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON 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 �(Q 2 3 C.'ctzEy GT'• Clrv/Zip C-7-2� 2- rn <br /> CROSS STREET SH-7 Ppfc APN 0- VZ. PARCEL SIZE <br /> 4-. .�-,. ` G D <br /> OWNER NAME O nI A 7'}-I N iv 0 7J /�l�VVI O� C��C.C I"tU�J PHONE 9 3o -o 9 3 I <br /> 41 <br /> OWNER ADDRESS 'S t�m E CrrY/STATE21P <br /> CONTRACTOR L-1 E 0A-K G-60 E,\)v I P- JMElf f1 L 3 7 <br /> PHONE tpC1`03ct. <br /> CONTRACTOR ADDRESS O pW— 57. CrrY/STATE/ZIP Ly/bI C^ <br /> LICENSE 0I..IC-42 ❑c7C-36 OTHER CECT NUMBER Z�S I EXPIRATION DATE <br /> `f�3y�ZZ <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> )S PERC TEST # I BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDMON ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT ❑ OUT-OF-SERVICE SEPTIC SYSTEM :. DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPEIMFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE To NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES ' LEACHING CHAMBERS #OF LINES LENGTH OF LINES f� r <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE z�jT <br /> / <br /> ❑ FILTER BED WIDTH ft LY <br /> LENGTH ft DEPTH Cee i^®I <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft C <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH IU 2 <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft 272020 <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH w-j.q C <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY UNE N UIN C01jVry <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTHEp EN^TEAL <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY UNE ft MTI YrZNT <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 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 OUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 <br /> SIGNED TITLE DATE <br /> DEPARTMENT US•E ONLY <br /> C— Date W,r 7�.ro,;7 Area q/q�1 Em ✓^ <br /> Application Accepted ByyI Employee ID# T�`p1 <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 Chec Amount ate Permit/ Invoice# Permit ID# <br /> Code INFO B ash Remitted Service Request# <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />