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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 1209 953-7697FOR1NSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS yyOs CrrY/ZIP_ /S1L�//'�/l� <br /> CROSS STREET U_ Z -9 � APN 00 Oma / 3P�ARCyEL�SIZE <br /> o5757;7OWNER NAME AC ' PHONE <br /> — <br /> OWNER ADDRESS CRY/STATE/ZIPJ!Jy y <br /> g <br /> CONTRACTOR ZGJ '4w/J PHONE <br /> CONTRACTOR ADDRESS 7yG byU ////� �iL CITY/STATE/ZIP <br /> LICENSE PC-42 " C--36 OTHER NUMBER S EXPIRATION DATE <br /> WATER TABLE DEPTH: ,3� ft 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-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE COMMERCIAL _ OTHER <br /> NUMBER OF LIVING UNITS: / NUMBER OF BEDROOMS: :3 NUMBER OF EMPLOYEES: <br /> SEPTIC TANK TYPE/MFG 7 CAPACITY /v_ - gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG v CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION zO� it PROPERTY LINE 5-O',A- ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP O PKG TX PLANT O SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES J S�� ft <br /> DISTANCE TO NEAREST WELL �yy ft FOUNDATION ft PROPERTY LINE �J 'f It <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LINE It <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 it <br /> DISTANCE TO NEAREST WELL ftFOUNDATIONFOUNDATION ft PROPERTY LINE ft <br /> PILSEEPAGE PITS NUMBER 3 WIDTH�-s. �O „ ft DEPTH � _ ft <br /> DISTANCE TO NEAREST W4OELL/ e It FOUNDATION PROPERTY LINE ,1� ft <br /> 1 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 /> MINIA#UM 48 NCE NOTICE REQUIRED FOR INSPECTIOPLEASE CALL(209)9Q-7697 <br /> SIGNED TITLE DATE PG <br /> i <br /> DEPARTMENTDEPARTMENTUSE ONLy N� <br /> Application Accepted By Date4�S ,' AreaFinal Inspection By Pi Date ❑ SPECIAL PERMIT!Character of Soil to Depth of 3 Ft: p Soil Character: <br /> COMMENTS tJeY-j .SCK. -r1er Al v./C11 �„�; }Hin 5� 'bac S .Dc'/ <br /> PE SC Received Amount Permit/ <br /> Code INFO B Date <br /> Cash Remitted Service Request# Invoice# Permit ID# <br /> -7 S1115 1k <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />