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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-REFUND LE PERMIT � <br /> CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS &L l .-] Go rra! kfl L- CITY/ZIP '7­0e� C,VJ' 2 <br /> / y <br /> 1^ V M <br /> CROSS STREET VV 1^(�l../LRi�I APN� t PARCEL SIZE p <br /> G Lt,. �. m 1 O <br /> OWNER NAME J tM IQ`1 l I.+-r, �'F- f ol-hi-c yi ti`I �}P-HONE <br /> OWNER ADDRESS 5�' � CITYISTATE/ZIP <br /> CONTRACTOR SQ PHONE y-5Lu <br /> fCG> <br /> CONTRACTOR ADDRESS YJ CyO l.��O CITY/STATEIZIP .cv;0t,­B^IG/L <br /> LICENSE ❑❑C-42 ❑0C-36 OTHER tf� NUMBER �kS;��EXPIRATION DATE �� <br /> WATER TABLE DEPTH: 7_ It GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: ❑a NEW INSTALLATION REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIV <br /> ❑ REPLACEMENT ❑ OUT-OF-SERVICE SEPTIC SYSTEM ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: 7�7SIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: 1 NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG CAPACITY gal/PRRTY <br /> ENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY galENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION R ft <br /> ❑ LIFTSTATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SANDOICLOSED SYSTEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES ENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION it PROPERTY LINE ft <br /> FILTER BED WIDTH 3,V It LENGTH ' DEPTH J6 . ft <br /> DISTANCE TO NEAREST WELL 6C)I ft FOUNDATION It PROPERTY LINE a2O I It <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH It <br /> DISTANCE TO NEAREST WELL it FOUNDATION it PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH It DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUN TION ft PROPERTY LINE it <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH It DEPTH It <br /> DISTANCE TO NEAREST WELL It OUNDATION 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 E WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> STATE LAWS AND RULE AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM 8 HOUR AIRVANCE NOTICE WEQUIRED FOR INSPECTIONS-PLEASE CALL(209)-953-7697 <br /> SIGNED TITLE �'�^ f Wit'-d�S r DATE !7 7 - 02n <br /> 4 O <br /> H <br /> Ni <br /> �j > DEPARTMENT USE ONLY <br /> Application Accepted By �—�-F- L L Date 7�y 1,W,,,)LArea l Employee ID# k <br /> Final Inspection By Date ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS (' wlc� td lrr.:cl1 ( J // Y i'rr� 1/�>r, ) /-/ �:,, 1/0 <br /> ll it G7 ��: 1�17� Sy5 I n� -A" ul. J:'1 '�' of <br /> Pxea1,15%,)r1 O'f' rn: s,Y'/qa�l !<<� <br /> PE SC Received he Amount Date Per <br /> miU Invoice# Permit ID# <br /> Code INFO B sh Remitted Service Request# <br /> 1c5'�-' i�� �3�J •2 •20 S�0082 S <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />