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• r <br /> 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 Zo j 6onja) CITY/ZIP ('"t• 64 C/S-Z30 r <br /> CROSS STREETI1104� P-,e�/y� 1 APN 0/7 - 27� 12 PARCEL SIZE <br /> OWNER NAME Je�'P�N'"'I /�- V/k- l ' G A�1�'D Tn(- PHONE &9LI- 3,. 7- 3 7 73 <br /> %r. <br /> OWNER ADDRESS �'� ! `/�' / �,�15 ° " &''51Y/STATE/ZIP <br /> CONTRACTOR /ti✓/�LiGiJ.� PHONE ?�`/' 3%7' 37-of <br /> CONTRACTOR ADDRESS L/O]' Ir�l�ti'I'✓�'�'1 L'J�LI/ CITY/STATE/ZIP ` <br /> LICENSE ❑IJC-42 111IC-36 OTHER CSV 11 Ln�1)ieE'r NUMBER y EXPIRATION DATE j 6 .7✓ <br /> /tic/U <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # 3 BUILDING PERMIT# LAND USE APPLICATION#�/�,Q <br /> TYPE OF WORK: LI NEW INSTALLATION REPAIR/ADDITION I.., ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT _ OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: C RESIDENCE ❑ COMMERCIAL C 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 LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL 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 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 Q HOUR ADAIANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 <br /> SIGNED zny TITLE If` �h�l(' DATE <br /> 271 wwwr <br /> EN O N <br /> we 47, <br /> H EARzw <br /> f DEPARTMENT USE ONLY <br /> Application Accepted By Date I1 7Jdu Area H/�q Employee ID# DA <br /> Final Inspection By Date 3 e C SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Su{mp Soil Character: <br /> COMMENTS 11 j e) � -L ll �t-.� �- �p�J S�� Iy O 'L( z <br /> PE SC Received Check#/ Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO By CaIph Remitted Service Re est# <br /> yaaa Sa3 �ys� 11 11a 2� S�2 00 <br /> 42-01 3 3 -7 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 �/!�/U/�,�y 111 <br />