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T ' <br /> C. NSrrE WASTEWATER TREATMENT SYSTEM PERMF <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 /> JOB ADDRESS CITY/ZIP / <br /> tf <br /> CROSS STREET G _ APN I+q la�D l PARCEL S�I}ZE tV <br /> OWNER NAME <br /> PHONE � 9�,3 <br /> OWNER ADDRESS �f JS J / �v�/Q;yIX� CITYISTATEIZ ���i� �A <br /> CONTRACTOR c/ � - PHONE `1/�?IP <br /> CONTRACTOR ADDRESS /UZ2� 1N�' CITY/STATE/ZIP �G-/\.'J� "—"4 <br /> LICENSE ❑UC-42 ❑UC-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: (J ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT 000 4,Yq LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION ❑ REPAIR/ADDITION X ENGINEER DESIGNED/ALTERNATIVE <br /> D REPLACEMENT n OUT-OF-SERVICE SEPTIC SYSTEM ❑ DESTRUCTION <br /> n <br /> ATION WILL SERVE: X RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> MBER OF LIVING UNITS: NUMBER OF BEDROOMS: 07- NUMBER OF EMPLOYEES: /J <br /> SEPTIC TANK TYPE/MFG CAPACITY D gal #OF COMPARTMENTS <br /> J-7 <br /> GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL l ft FOUNDATION ,4 ft PROPERTY LINE �- ft <br /> d LIFT STATION SIZV, TYPE OF PUMP ❑ PKG TX PLANT ® SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> n <br /> ® LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE To NEAREST WELL ft ,FOUNDATION ft PROPER LINE, 1' ft <br /> FILTER BED WIDTH ft LENGTH e� ft DEPTH. -2- ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> Q MOUNDED WIDTH ft LENGTH / ft DEPTH ft <br /> DISTANCE TO NEAREST WELL��S/ ft FOUNDATION / b ft PROPERTY LINE_ 5, '}' 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 /> C� 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 /> MINIANW48HOQUAD NCE NOTICE REQUIRED FOR INSPECTIONS -PLEASE CALL 209 953-769 , n <br /> SIGNED TITLE [/� 12� DATE 142-0 <br /> Ior <br /> Q <br /> T Oki <br /> T <br /> DEPARTMENT JISV ONLY r�� <br /> Application Accepted B v Date O b a0 Area .� Employee ID# UA <br /> Final Inspection By Date � i� ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS IVe 4er✓1 -f SP.Gond SFP- %n a ,r S �2 InoX C1. 3h O I "e <br /> i <br /> is i t/1 • -P4 -J' Coww- ; I�►�Od <br /> 0.111 fir' r u rnos AWLJ A,14-r <br /> PE SC Received heck Amount Permit/ <br /> Code INFO By ash Remitted Date Service Request# Invoice# Permit ID# <br /> qa o Sao <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />