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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)4683420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR/NSPEcnom EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS Q S C CITYILP 4 <br /> CROSS STREET APN 0I4�Z)V PARCEL SUE ID, <br /> OWNER NAME D-n 1!�Ai.lV�r'/G u/�`!1�s �// �G�1J I L�I1'1 C:'I LPH�OINE <br /> OMIERADDRESS .� BJ/� F��/111'.l,74 QTYISTATEOP S/—.k4' qS�C� <br /> CONTRACTOR (.P�1�rt VQ(/%/��• ��' �/�j� /y PHONE ao?C-�G '-S'0..� <br /> CONTRACTOR ADDRESS 3/ �& /'u,l.���N �Zf LC- (/� c/CITYISTATE/LP ✓ �� <br /> LICENSE 1N2 C36 OTHER NUMBER `O J ExmmnoN DATE <br /> WATER TABLE DEPTH: It GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST EBUILDING PERMIT# Y 7 LAND USE APPLICATK)N# <br /> TYPE OF WORK: NEW INSTALLATION REPAIR/ADomoN ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRucnoN <br /> INSTALLATION WILL SERVE: >RESIDENCE COMMERCIAL OTHER <br /> NUMBER OF LMNG UNITS: 401 NUMBER OF BEDROOMS: 41����//��O NUMBER OF EMPLOYEES: <br /> SEPTIC TANK TYPE/MFG �' CAPACITY /H.i'� gal #OF COMPARTMENTS O' <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTSQ <br /> DISTANCE TO NEAREST: WELL/� ft FOUNDATION�(2 ft PROPERTY LINE f30 ' ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> x ' <br /> LEACH LINES LEACHING CHAMBERS #OFLNES C31 LENGTH OF LIMES `. ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE So It <br /> ❑ FILTER BED WIDTH ft LENGTH It DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WOTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY UNE It <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY UNE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL It FOU TON It PROPERTY UNE It <br /> SEEPAGE PITS NUMB" �3 WIDTH ' �_� ft DEPTH oz$1 ft <br /> DISTANCE TO EST WELL 0 R FOUNDATION �P.O R 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. G <br /> MINIMUM 48 HOUR ADVANCE N9 REQUIRED FOR INSPECTIONS- CALL(209)953-ZRZ <br /> SIGNED TITLE DATE / 20 GNU <br /> DEPARTN✓ H�n FO <br /> Application Accepted By� �L' Date Area Employee ID# �O� <br /> Final Inspection �Q4, <br /> pe By Date � SPECIAL PERMIT-Approved by ('� 'O �.1w O <br /> Character ofSolltoDWSof3 a"Clnractw. 'o �C u <br /> COMMENTS 5 R Pi/ 7T, U,,4 lary 12paAeS6 C <br /> Hum " S.J C,worl 0 /a a ;m raYl� FNT <br /> S C to -414 W hF J71,1s IV 40"4jlrl / B )0 110113030 OtaPE 3C _'1 U <br /> Code Ale <br /> M �� RearllMd DIM �� d# I www Permit ION �,i` <br /> II I 57 <br /> R.stoj��1��' <br /> f'kInekNi- A <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 1/14/18 <br />