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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 /> JOB ADDRESS 2 S3 �/ �P/ �� CITY/ZIP SC- `' ,, <br /> 1 �J ) / 7 tT <br /> CROSS STREET �S�'��� A O 7 APN �a r 2 t' V �/ PARCEL SIZE + 2 <br /> 0 <br /> - <br /> OWNER NAME /yJ`Z /���e(' PHONE U <br /> OWNER ADDRESSF/� / � ` CITY/STATE/ZIP L L C-A <br /> CONTRACTOR / ���/��/ ��,r�C 'C"'fe^ PHONE <br /> CONTRACTOR ADDRESS / ne�/�'� ` C� CITY/STATE/ZIP <br /> LICENSE ❑CIC-42 ❑IIC-36 OTHER ! ' NUMBER-?(j C-/)3 EXPIRATION DATE Q171 <br /> WATER TABLE DEPTH: I >0 ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: I l NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE <br /> I:i REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM I DESTRUCTION <br /> INSTALLATION WILL SERVE: RESID NCE El COMMERCIAL El OTHER <br /> NUMBER OF LIVING UNITS: I IFX NUMBER OF BEDROOMS: h 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 V LEACHING CHAMBERS Z� j #OF LINES Z LENGTH OF LINES �� ft <br /> DISTANCE TO NEAREST WELL ?OJ ft FOUNDATION ft PROPERTY LINE - 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 Y WIDTH V ft DEPTH -2 ft <br /> DISTANCE TO NEAREST WELL2.00 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 8 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS- PLEASE CALL 209 953-7697 <br /> SIGNED TITLE ✓/ DATE <br /> A <br /> V UI <br /> D N <br /> / DEPARTMENT USE.ONLY /� ti1F <br /> Application Accepted By — LG Date 101lej ldodo Area I Employee ID# �D <br /> Final Inspection By--A . �� Date ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ftpp PitIS mp Soil Character: <br /> COMMENTS LJ bine- h-)IrUSfY✓1P✓1� /V100✓74 1}nPs -fC YYI�,eP IPGL','kmP17451j 11 , IiJh�;� o . Pears fi e <br /> r I }cel r h i r Y, Tr o r <br /> rn,� <br /> PE Sc Received heck#/ Amount Permit/ <br /> Code INFO By Cash Remitted Date Service Request# Invoice# Permit ID# <br /> iia i i t s ��o �0 1 Z� 00 <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />