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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 <br /> PERMIT CALL(2099)9)53-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS �b 7 �J �j ueje-S /r��C CITY/ZIP Zll:Ct% <br /> ll <br /> CROSS STREET G/L �� APN oO��L'D D2 PARCEL SIZE Q �� p <br /> 0 <br /> z <br /> OWNER NAME / /�/y1S /�:uPz� PHONE y <br /> OWNER ADDRESS J CITY/STATE/ZIP ^7 <br /> CONTRACTOR �r l f�i7��u �/Jy7 ` ]] PHONE 7j�o�1'�OZ/ <br /> CONTRACTOR ADDRESS � CRJ P �Jl/� /�x CITY/STATE/ZIP <br /> LICENSE ❑WC-42 01-IC-36 OTHER_ NUMBER /�`I EXPIRATION DATE O ello%h/ <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # ] BUILDING PERMIT0 7a LAND USE APPLICATION I# <br /> TYPE OF WORK: ❑ NEW INSTALLATION REPAIR/ADDITION LI ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT LI OUT-OF-SERVICE SEPTIC SYSTEM ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE /r-COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: 7 NUMBER OF EMPLOYEES: pp <br /> SEPTIC TANK TYPE/MFG �fQr� Z CAPACITY gal #OF COMPARTMENTS 1 <br /> GREASE TRAP TYPE/MFG PL CAPACITY l gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ZOO ft FOUNDATION Z5- ft PROPERTY LINE Zw'� ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> {� LEACH LINES W—LEACHING CHAMBERS #OF LINES LENGTH OF LINES /!.Y> J ft <br /> DISTANCE To NEAREST WELL Z00;i4- ft FOUNDATION 50 ft PROPERTY LINE ZI 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 DATE <br /> mo <br /> w, <br /> S 1 <br /> E V IN o <br /> DEPARTMENT USE ONLY �THDEpgRTT'� '1 /! <br /> Application Acceptd B f' 1 Date v70�n0 Area% Emplo�eeNl�# yN <br /> Final Inspection By_' p Date lg �Z,,O ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: _ Pit/Sump Soil Character: <br /> COMMENTS Q.�O)'hgr bc- ►.inn �,, /S"v1�c:bl�Il�/ CAYC) llfiCl}E Zr,er 22eh S1 d SSN4S (ye"fl.'/ !� Zc:l3. <br /> T <br /> F�IA,/e cidd,k),?" iP Iii Oir_ , / I„j ; ) �J <br /> Nis G -- - --��- Av&I,C wot tiro <br /> PE SC Received Chec Amount Date Permit] Invoice# Permit ID# <br /> Code INFO B ash Remitted Service Reguest# <br /> ya <br /> S, '29)9) 2 4S?L <br /> Alt tlA r LO✓lY1Q L <br /> 42-01 / - —• �I q Gf - I P'k7)uNSI E WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 -6-0✓�'1 �?�1 S' ✓� S "t �d^ LOI�tN�l Zp p© e✓bl0►�► <br /> y y <br /> Otit Gowipa+-f'rhl-n-� SeP- 2 �'Q.2�G <br />