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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 W ' CITY/ZIP ✓I k" <br /> /� <br /> C7:�Oa 3 PARCEL SIZE ��' `'`' p <br /> CROSS STREET !J Z�7 . APN Oc <br /> 0 <br /> i <br /> OWNER NAME <br /> L� L7%lI ' i� PHONE <br /> OWNERADDRESS 1400 D0(,"]&< JI 1z)j2 CITY/STATEIZIP h <br /> CONTRACTOR �h43,tiI VO//. <br /> / PHONE 20 , <br /> CONTRACTOR ADDRESS 7L0j� /✓7Lui �� (/J�� pp // CITY/STATE/ZIP J�C <br /> LICENSE 111,t1 -42 ❑.IC-36 OTHER NUMBER /�/DSEXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# O LAND USE APPLICATION#I <br /> TYPE OF WORK: I NEW INSTALLATION REPAIR/ADDITION I I ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT 0 OUT-OF-SERVICE SEPTIC SYSTEM I DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> SEPTIC TANK TYPE/MFG — CAPACITY �o0 gal #OF COMPARTMENTS <br /> U GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> -fin <br /> DISTANCE TO NEAREST: WELL o?00 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 345 C4V41/T,r'I #OF LINES _� LENGTH OF LINES 7-S / ft <br /> DISTANCE TO NEAREST WELL c 1190 ft FOUNDATION p9 ' ft PROPERTY LINE -?D 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 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL 209 953-7697 <br /> SIGNED TITLE � rG'l DATE <br /> A <br /> T M <br /> T <br /> DEPARTMENT USE NLY <br /> Application Accepted Date 10 S Area S Employee ID# <br /> Final Inspection Byt n l Date SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Ph/SuA Soil Character: <br /> COMMENTS fD C,/PS:b-V SE b>/Z f1-lik f<SU004cz ,S07, e4 4j,15j7N C nd- <br /> YIFvd fan ��mc� ��bo.0 �c1�K c:rt(� �•r/,(o�x �Ljd of LrCedlrl '`IS OP7- <br /> l i s <br /> PE SC Received eck# Amount Date Permit/ Invoice# Permit ID#. Nb <br /> Code INFO By Cas Remitted Service Request# <br /> u/N jrS- 23 ��� 0 4� 2a SR008� 7 S 5t <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />