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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 /> S3 Z' <br /> JOB ADDRESS / --S 1`� CITY/ZIP ��C- 4J I <br /> p� � <br /> CROSS STREETAPN Joe, 2U j S �� PARCEL SIZE / 7 7�0 <br /> OWNER NAME �h,� rel C=, S4.v?fie PHONE <br /> OWNER ADDRESS //�► r/I (� CITY/STATE/ZIPS <br /> CONTRACTOR / 1���//fLF��c �1`a. �` T �C� PHONE <br /> CONTRACTOR ADDRESS /7 d yT CITY/STATE/ZIP �� / `�' <br /> LICENSE ❑I_IC112 ❑JC-36 OTHER NUMBER ��� �J� EXPIRATION DATE 3°/L .Z <br /> WATER TABLE DEPTH: 3 S ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION A REPAIRIADDITION I I ENGINEER DESIGNED/ALTERNATIVE <br /> 4 REPLACEMENT leA A I OUT-OF-SERVICE SEPTIC SYSTEM I I DESTRUCTION <br /> FINSTALLATION WILL SERVE: LTJ RESIDENCE ❑ COMMERCIAL ❑ 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 It FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ElLEACH LINES !d LEACHING CHAMBERS y T #OF LINES 3 LENGTH OF LINES /0 3 ft <br /> DISTANCE TO NEAREST WELL dJ c ft FOUNDATION yv� 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 It 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 HQ9R ADVANCE NOTICE REQUIRED FOR INSPECTIONS- PLEASE CALL 209 953-7697 <br /> SIGNED �/ �'� TITLE ('L%,�¢r��� DATE <br /> w <br /> luz <br /> Q <br /> A UI <br /> LTft Ell; ;44L r?H+ <br /> DEPARTMENT USE ONLY ENT <br /> Application Accepted By G Date D 1 O V Area S Employee ID#_ <br /> Final Inspection By-A Date ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pi Sump Soil Character: <br /> COMMENTS Fyllule of lines, wsfew z)n two)), lot. Pef - un>zy :recetds- zyo <br /> P,I�s w ohm z �1 p r li 5. <br /> 5 X . Wv�j w w A.",:) <br /> PE SC Received (CheSW Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO By ash Remitted Service Request# <br /> 431LJ )15- G <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />