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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 SS z �/q �� CITY/ZIP <br /> CROSS STREET /C�r✓w�c C_ �tcJ APN 0 86 5 3 03,�2 PAR/CEL SIIZE� <br /> OWNER NAME [�U/LtIP�(//� /��Jl[/Jp7L PHONE.��G/��O/QJ.o./ m <br /> OWNER ADDRESS / Q. /Y},fry� �!SS CITY/STATE/ZIP <G /- +^^'-' /S_ ✓, <br /> CONTRACTOR LfI7 4 � -cJ /fes ri PHONE �(p/_7 ep_ -� - <br /> CONTRACTOR ADDRESS �L� ��i� //.� �/ CITY/STATE/ZIP <br /> LICENSE 42 ❑I IC-36 OTHER NUMBER O/ EXPIRATION DATE O <br /> WATER TABLE DEPTH: 1 J ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# g F 179o?C/ LAND USE APPLICATION# <br /> TYPE OF WORK: pt-_ NEW INSTALLATION REPAIR/ADDITION 1 ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIALC OTHER <br /> NUMBER OF LIVING UNITS: I NUMBER OF BEDROOMS: 4-1 NUMBER OF EMPLOYEES: <br /> Qoi SEPTIC TANK TYPE/MFG './f� 2 CAPACITY �� gal #OF COMPARTMENTS_ <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS� <br /> DISTANCE TO NEAREST: WELL Z00",` ft FOUNDATION ft PROPERTY LINE 7^7" ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES LEACHING CHAMBERS #OF LINES &pZ LENGTH OF LINES SS r It <br /> DISTANCE TO NEAREST WELL 7VO I ft FOUNDATION 42E ft PROPERTY LINE 10 ft <br /> ❑ FILTER BED WIDTH ft LENGTH It 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 /> 61- DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL /ft FOUNDATION ft PROPERTY LINE ft <br /> SEEPAGE PITS NUMBER rF WIDTH �(�j�� ft DEPTH d��l ft <br /> DISTANCE TO NEAREST WELL 510.'- ft FOUNDATION ft PROPERTY LINE /D 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 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 <br /> SIGNED TITLE DATE 3 <br /> V1, <br /> ♦ ti <br /> S <br /> IV <br /> 1 p <br /> P <br /> DEPARTMENTU-SE ONLAO <br /> IAL <br /> NN <br /> T <br /> Application Accepted BpDate 3 � <br /> u <br /> Final Inspection By n 4^ Date 2K170ZO C SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: I Pit/Sump Soil Character: <br /> COMMENTS /'ilei✓ SFR :Ver <br /> PE SC Received thecko Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO B Remitted Service a uest# <br /> Mal) 11-7 1st 67 3 ?u 2 <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />