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ONSFTE 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 <br /> EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS <br /> CITY/ZIP <br /> CROSS STREET yCJ �nyl <br /> APN D �%0 PARCEL <br /> aSIZE <br /> O <br /> OWNER NAME hb <br /> PHONE <br /> OWNER ADDRESSCh <br /> CONTRACTOR JIF67 <br /> b14w Op? CITY/STATE/ZIP * tHh <br /> / L PHONE_ 3Gy-S-OZ7 <br /> CONTRACTOR ADDRESS 3z�!z ti �l���� ��'�/� ,��/ CITY/STATE/ZIP <br /> LICENSE ❑NZ-42 ❑❑C-36 OTHER NUMBER S`9UyS— EXPIRATION DATE dVO/�/ <br /> WATER TABLE DEPTH: Co 0 ft GEOGRAPHICAL INFORMATION: Coordinates X <br /> Y <br /> ❑ PERC TEST # BUILDING PERMIT# % CJQf r� <br /> TYPE OF WnRK: kNEW INSTALLATION7 y� SAND USE APPLICATION# <br /> ❑ REPAIR/ADDITION ❑ ENGINEERDESIGNED/ LTERNATIVE <br /> l <br /> ❑ REPLACEMENT ❑ OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION /G,I1 K <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE <br /> L^%COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: <br /> NUMBER OF EMPLOYEES: Ir <br /> 19L SEPTIC TANK TYPE/MFG CAPACITY 1`A=— <br /> ® GREASE TRAP TYPE/MFG gal #OF COMPARTMENTS,_ <br /> CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL <br /> _ ft FOUNDATION /D ft PROPERTY LINE —�V� ft <br /> f <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 ,ya , ft <br /> DISTANCE TO NEAREST WELL__/-570 r It FOUNDATION_ gV <br /> ft PROPERTY LINE /Q ft <br /> ® FILTER BED WIDTH It LENGTH ft DEPTH <br /> ft <br /> DISTANCE TO NEAREST WELL it FOUNDATION It PROPERTY LINE It <br /> MOUNDED WIDTH ft LENGTH ft DEPTH <br /> ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> L3 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_. WIDTHS SSS ft DEPTH S' ft <br /> DISTANCE TO NEAREST WELL�J ft FOUNDATION PROPERTY LINE_ it}'� 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�J� ���— <br /> TITLE��y� DATE O <br /> -------------- <br /> ----------------------------+ <br /> 17 ———JUN <br /> r <br /> E V! � U <br /> D <br /> DEPARTMENT USE ONLY <br /> Application Accepted By Date 7 Area / �� Employee ID# DA <br /> Final Inspection By 114fN\ Date_ I z' ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: SAVNOy to KLk Pit/Sump Soil Character: LO P!t L S'Pia'O <br /> COMMENTS eVJ CayY1MUZI`dl /VLSS SAV O,?a3$6' Pyblic wa+er well on pY-op!e(3y <br /> I I <br /> 0 I a-AyW u i fal.F.t�►fez Sti R yt-a. T+VVZ W- 0" AA-V SA3 <br /> VA w V X40& <br /> PE SC Received Chec Amount Date Permit/Code <br /> Invoice# Permit ID# <br /> INFO ash Remitted Service Re uest# <br /> 6 sa 22• 2Z <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PEWT <br /> 4/14/18 <br />