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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 PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS /l CITY/ZIP <br /> CROSS STREET 1 Y O APN PARCEL SIZED // y <br /> OWNER NAME 11YYI/Ytt/ /o 7Z j Z I PHONE <br /> ;n <br /> OWNER ADDRESS / CITY/STATE/ZIP <br /> CONTRACTOR 45 M L ell A., /Jhc'. PHONE <br /> -7t/ �'-- �__//tom 7��,/� ��� CITY/STATE/ZIP <br /> CONTRACTOR ADDRESS 3< YC 6,L G <br /> LICENSE ❑V.0-42 ❑1 C/-36 �1OTHER NUMBER �SIO�/S EXPIRATION DATE d 51/JV <br /> WATER TABLE DEPTH: /V ?o ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: I NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE <br /> 1 REPLACEMENT I OUT-OF-SERVICE SEPTIC SYSTEM I DESTRUCTION <br /> INSTALLATION WILL SERVE: [-RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: 1 NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> �- SEPTIC TANK TYPE/MFG CAPACITY ZtiU gal #OF COMPARTMENTS Z- <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL_zoo ft FOUNDATION l0 ft PROPERTY LINE %60 t' ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES /GAJ I ft <br /> DISTANCE TO NEAREST WELL 1W ✓' ft FOUNDATION 7 / ft PROPERTY LINE /OO 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 20 953-7697 <br /> SIGNED �� TITLE /.rte DATE /7-16 -ZO <br /> Trw <br /> DEPARTMENT USE NLY <br /> Application Accepted B A t It Date -7-11,IV <br /> i �yt0 Area / C Employee ID# <br /> Final Inspection By Date 1211-71',/�19 ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: V J Pit/Sump Soil Character: <br /> COMMENTS <br /> PE SC Received / dttcj41 Amount Permit/ <br /> Code INFO B Cash Remitted Date Service Request# Invoice# Permit ID# <br /> 300 <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />