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- 1 <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)a68-347.0 <br /> NON-REFUNDABLEPPERMIT CALL(209)� 95`3-7-6697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED 7 7 S• 1,60 4,le,- /G��4I' CITY/ZIP <br /> JOB ADDRESS <br /> CROSS STREET Do,? mjU _ APN � ����-3 PARCEL SIZE <br /> Lr'� p I <br /> OWNER NAME TI � LJ/r���))' CC�G1(��2�,i� yZ+�'H�J -�^ PHONE <br /> OWNER ADDRESS d'2011 .SJ Af,{TI» l`�/� CITY/STATE/ZIP �1 DOPI <br /> CONTRACTOR ��Hwy� Vl7 <� l_- PHONE O � —���/ <br /> CONTRACTOR ADDRESS I,L7� !/!u� ' CITY/STATE/ZIP S�-c <br /> LICENSE ❑OC-42 ❑0C-36 OTHER NUMBER 5 /S EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT#]&F— M03106 LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION 11REPAIR/ADDITION LI ENGINEER DESIGNED/ALTERNATIVE <br /> 0 REPLACEMENT ❑ OUT-OF-SERVICE SEPTIC SYSTEM ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: (� NUMBER OF BEDROOMS: —3 NUMBER OF EMPLOYEES: <br /> SEPTIC TANK TYPE/MFG ��y]�GLC / /'YC- CAPACITY 14900 gal #OF COMPARTMENTS <br /> U GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> J i <br /> DISTANCE TO NEAREST: WELL /00 ft FOUNDATION S , ft PROPERTY LINE /7L- ft <br /> El LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT Q SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES ❑ LEACHING CHAMBERS #OF LINES _ LENGTH OF LINES &O ft <br /> / <br /> DISTANCE TO NEAREST WELL l00 / ft FOUNDATION 30 ft PROPERTY LINE /0 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 /> Ll 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 � TITLE401104a/.- DATE Tao <br /> fikki <br /> T <br /> D <br /> AW 0 <br /> A UI C TY <br /> E TA 1. <br /> r <br /> �JDEPARTMENT USE ONLY <br /> Application Accepted �J/�L� Date c�nn��nn Area VI Employee ID# $�C <br /> Final Inspection ByDate ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: IF Pit/Sump Soil Character: <br /> COMMENTS <br /> 1\1e L4 S FR. Ther ff <br /> PE SC Received Check#/ Amount Dat Permit/ Invoice# Permit ID# <br /> Code INFO Ca Remitted Seg quest# <br /> ya► <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/4/18 <br />