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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 pCALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 1 -735 Wtsi- Lade. CITY/ZIP 51DCK+V() 95205 <br /> CROSS STREET Gj Gt C o I I APN I 1:21@D PARCEL SIZE I <br /> OWNER NAME 1 bL7-dkr PHONE 2-09- UI 5p- V 5 9 LR <br /> CA <br /> ( ^ �/ <br /> OWNER ADDRESS X10�1 3 1 onnrc DY-741e_ CITY/STATE/ZIP YA 5252_ <br /> CONTRACTOR 3`I- PHONE — 2 <br /> CONTRACTOR ADDRESS CITY/STATE/ZIP <br /> LICENSE ❑--C-42 ❑1 IC-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION I I ENGINEER DESIGNED IALTERNATIy E <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION SC' ti }i• 1 I C <br /> INSTALLATION WILL SERVE: ❑ 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 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 /> ❑ SEEPAGEPIT NUMBER WIDTH ft DEPTH ft <br /> DISTA r <br /> E TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> I HEREBY CERTI TH HA EPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> 14 STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIM HOU AGIVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 ^ <br /> SIGNED TITLE UWY)pr DATE C 2D <br /> E V IN C <br /> H N L <br /> S T <br /> DEPARTMENTU EONLY q <br /> Application Accepted B �� Date C 0 Area Employee ID# DA <br /> Final Inspection By ` Date ZQ ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Su p Soil Char afjt�er: <br /> COMMENTS GolnecfIi,Drr cill SF'Vjer- ` CT,�d� D elct <br /> Sir 0�✓► �`(. � �l/t r� �,,� � til- - <br /> PE SC Received Check#/ Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO By Cash Remitted Service Request# <br /> 9dO 1 L " 1 sa I{ 2(J 2oeq <br /> 4II ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 119 ?; ( <br />