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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 / J' ) CALL(209 953-7697 FOR INSPECTIONST/� EXlPI <br /> ARES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 61 i/ LAC^ I��I CITY/ZIP j { rG �t <br /> CROSS STREET T�a s l�r APN �� - 23 <br /> PARCEL SIZE 1,q(3 <br /> 0 <br /> `s A <br /> OWNER NAME rLa.V� V, <br /> PHONE <br /> OWNERADDRESS Jb�O u,♦ pCG� CITYISTATE/ZIP �]�Y�`�Y <br /> v 11,` LS rn��.C-I�L A'5/ PHONE L4 57-DD—3&(r S <br /> CONTRACTOR y -1 +d <br /> CONTRACTOR ADDRESS 7 '•' lLh'7:C to–&t•s CITY/STATE/ZIP }' Y 1 nv,�a? 14-4 �✓ �.� <br /> LICENSE ❑:-1C-42 ❑1LIC-36 OTHER NUMBERG S� EXPIRATION DATE am oL• <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# A 7%2:}S� LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE <br /> L REPLACEMENT I OUT-OF-SERVICE SEPTIC SYSTEM 11 DESTRUCTION <br /> 7INSTAATION WILL SERVE: p RESIDENCE [I COMMERCIAL <br /> ) [IOTHER <br /> NUMBER OF LIVING UNITS: �1 NUMBER OF BEDROOMS: 1 NUMBER OF EMPLOYEES: <br /> Ul000'SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS -� <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> � <br /> DISTANCE TO NEAREST: WELL t^n! ft FOUNDATION L! ft PROPERTY LINE �.5 ft <br /> E3 LIFTSTATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> I <br /> LEACH LINES L LEACHING CHAMBERS #OF LINES _ LENGTH OF LINES �c5 ft <br /> DISTANCE TO NEAREST WELL t'eI ft FOUNDATION 15 ft PROPERTY LINE 10I 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 /> MINIMUM 48&OUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS -PLEASE CALL 209 953-7697 <br /> SIGNED TITLE 'YC-'Aw DATE I!S 34— 0jr- <br /> ITr <br /> UI C l] <br /> N IR N ETA <br /> ff <br /> DEPARTMENT -USE ONLY <br /> Application Accepted By �!i Date O 0 O Area $ �� Employee ID#�_ <br /> Final Inspection By Date Ili i �j ZOL� ❑ SPECIAL PERMIT -Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS /vf;VJ 6FL7 -r-ler A1) idel S 0vjy1`oje 6FSe ticks ner (,otrn�1 rr(,6rt <br /> PE SC Received Check#/ Amount at Permit/ Invoice# Permit ID# <br /> Code INFO y Cash Remitted Service Request# <br /> LD I I 117 s8 _. O <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />