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• <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-7420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 11WM Umsvulcm, kci. -CITY/ZIP j2L in <br /> CROSS STREET 1 n tJLY�{ •/. APN 0Q73 d,)D.5 PARClE,LSME <br /> OWNER NAME -�•c�-•�� �j <br /> �£_� Y�YZtT K/V PHONE W(� •a IO ;7 Gf��, a <br /> OWNER ADDRESS t� /�[A� CIJ11Ant/�Qi CITY/STATE/ZIP 2� zG <br /> CONTRACTOR_" L 1YJ-{.]�l �Z (lYP 4 Inc PHONE �M ' '3J3l - '7�✓.1 1!t <br /> CONTRACTOR ADDRESS (t CLCJL(,(,J[� I �7, 4 CRY/STATEMP <br /> U', <br /> G��I <br /> LICENSE ❑-C-42 F.'-C-36 OTHER NUMBER VEXPIRATION DATE <br /> WATER TABLE DEPTH: R GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: _ NEW INSTALLATION REPAIR/ADDITION _ ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-0F-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 981 #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPEIMFG CAPACITY <br /> gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFT STATION SIIZE— TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES G� LEACHING CHAMBERS ,I1Y'1 tGL'1L'YS #OFLINES�_ LENGTHOFLINES CVl ft <br /> DISTANCE TO NEAREST WELL %C)C)_R FOUNDATION R PROPERTY UNE ..]} ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTYLINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELLit FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELLft FOUNDATION ft PROPERTY LINE it <br /> SEEPAGE PITS NUMBER Z WIDTH 3(L`)-- It DEPTH_ •2_t)) ft <br /> DISTANCE TO NEAREST WELL C ft FOUNDATION I It PROPERTY LINE J It <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. j <br /> SIGNED TITLE l: 'Y DATE 1.25 I <br /> FCEFNT <br /> LVED <br /> I <br /> P 29 2020 <br /> R <br /> -4 lletp(V ONM COVNTy <br /> � 4EPgRTMENT <br /> I <br /> / EPA RTMENT 5 ONLY Lr <br /> Application Accepted B �✓� Date !' O.?L7 Area / Employee ID#_ 014_ <br /> Final Ins ctfon B <br /> Pe y Date C SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: PW ump Soil Character: <br /> COMMENTS I I w1P-O1�r /InF� � U:?c o�'m fPc73o�r. t 't,;- _?, IE <br /> Lk k <br /> r - <br /> PE SC Received Check#! Amount Date PermlU Invoice# Permit ID# <br /> Code INFO Cas Remitted Service Rawest# <br /> 42-0 S ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />