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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 r� r '�y1���1�L CITY/ZIP /-i• 61 17,t �7 <br /> // pp '22 <br /> CROSS STREET l�l In �-A APN PARCEL SIZE 7 7 C1(l24 atv <br /> p L LIP <br /> OWNER NAME 1 YIIc��X ^� d0 ,X01 f PHONE y <br /> OWNER ADDRESS <br /> }��-11�VL1l�f-� CITY/STATE/ZIP <br /> CONTRACTOR l �C� ♦��)L�151'�FnV�P�IQ'� Y PHONE <br /> CONTRACTOR ADDRESS J�'1G'� M%rut' C,'r *�fl,"1 CITY/STATE/ZIP ✓1�ry�J l-C� ��T. <br /> LICENSE ❑l IC-42 ❑❑C-36 OTHER NUMBER ~gzz EXPIRATION DATE >'V ' Z Z. <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORM ION: COOrdI a s X Y <br /> ❑ PERC TEST # BUILDING PERMIT# AND USE APPLICATION# <br /> TYPE OF WORK: /k NEW INSTALLATION l REPAIR/ADDITION i I ENGINEER DESIGNED IALTERNATI E <br /> ❑ REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION vj <br /> INSTALLATION WILL SERVE: /If] RESIDENCE ❑ COMMERCIAL Ef OTHER <br /> ii <br /> NUMBER OF LIVING UNITS: 1 NUMBER OF BEDROOMS: t- NUMBER OF EMPLOYEES: <br /> T81 SEPTIC TANK TYPE/MFG•r nLk CAPACITY 1&0 gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL `ZC)['.• ft FOUNDATION ft PROPERTY LINE 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"Z ft <br /> DISTANCE To NEAREST WEL'P,' OO ft FOUNDATION 3O ft PROPERTY LINE ,^�!D© D 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 ft <br /> .7AREST WELL ft FOUNDATION ft PROPERTY LINE <br /> SEEPAGE PITS NUMBER ! WIDTH :Ny" ft DEPTH "Z5 ft <br /> I <br /> DISTANCE TO NEAREST WELL ?Q_0 ft FOUNDATION 6Y)4- 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 /> 1 <br /> 1 ' <br /> /� I <br /> `' L <br /> it <br /> N /RIry CO <br /> � EP <br /> } Z!+ <br /> Q. <br /> DEPARTMENT USE ONLY <br /> Application Accepted B Date Z Area A Employee ID# <br /> 1' <br /> Final Inspection By. Date 0li ❑ SaL PERMIT-Approved by <br /> Character of Soil to Pepth of 3 Ft: j Pit/Sump Soil Character: <br /> COMMENTS undur <br /> � a \j A Q2 N D <br /> PE SC Received hec Amount Permit/ <br /> Code INFO By Cash Remitted Date Service Request# Invoice# Permit ID#�C <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />