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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 7 CALL 209 953-7699,7 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS ZZ /T -+' Z 3 Ce E. �I�-y IBJ CfTYIZIP L_U 1�I R <br /> CROSS STREET L-E�C�rS -t' b <br /> APN Q�D1 ()—DI —O� PARCEL SIZE `� ' <br /> OWNER NAME D � Wf l�G PHONE (009 <br /> �/ G N <br /> OWNER ADDRESS P•U 3✓T �O� CITY/STATE/ZIP CL.t-x'1'1 AJTS GA <br /> CONTRACTOR LAVE Orw— PHONE 3isC1 - 03-1 9- <br /> CONTRACTOR ADDRESS 40-7 W Q'KV- ST• CrrY/STATE/ZIP I.OD ( CA <br /> LICENSE ❑ITC-42 ❑OC36 OTHER Py NUMBER O�I�I EXPIRATION DATE L/hobC) <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# A- 11 DU;;Q <br /> TYPE OF WORK: U NEW INSTALLATION REPAIR/ADDmON C ENGINEER DESIGNED/ALTERNATIVE <br /> 0 REPLACEMENT :7 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 TYPE/MFG 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 .7 LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY UNE 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 /> 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 /> M/NIMU M'{�H(OOUUfR A NCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 <br /> SIGNED �`/` F- _. TITLE PK(7.I ��2 DATE <br /> r ' . <br /> n a s <br /> Jill <br /> q 7- <br /> _ 6z T <br /> UY <br /> x�aJOAQ <br /> M. <br /> Application Accepted By G �!� Date 71;7411,2 D,L) Area I E T�, O 7y <br /> Final Inspection By Date ❑ SPECIALPERMIT-Approve �IM;ZA <br /> Character of Soil to Depth of 3 Ft: PivSump Soil Character: T <br /> COMMENTS <br /> PE Sc Received Check#/ Amount Date Permit/ <br /> Code PermitlD# <br /> Code INFO B Remitted Service Re uest# <br /> SQ 3 <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />