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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 186E E HAZELTON AVENUE-STOCKTON CA 95205-(209)4683420 <br /> NON-REFUNDABLE PERMIT �j CALL 20-9/ 953-7697 FOR INSPEC710NS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS ✓ER�r7 /3, c4,- �U CITYMP o � <br /> CROSS STREET C�L r �-(,� APN '✓'"' .. � .. f' PARCEL Sin <br /> C <br /> OWNER NAME PHONE <br /> OWNER ADDRESS / // / CITY/STATEMP <br /> CONTRACTOR 6&1-1v l 114f e. *6•-c PHONE do'? "c Act so7 <br /> C/�] <br /> CONTRACTOR ADDRESS 3/ l v I"HI ��/ Vr CITYISTATE/LP ✓ K `� J�J <br /> LICENSE ',�-42 C36 OTHER NUMBER 'EIPIRAnoNDATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST # _ 1 BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: A NEW INSTALLATION REPAIRIADDITION ENGINEER DESIGNED IALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTI:SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE COMMERCIAL OTHER <br /> NUMBER OF LMNG UNITS: NUMBER OF BEDROOMS: �?- NUMBER OF EMPLOYEES: <br /> ASEPTIC TANK TYPE/MFG P14Sb G CAPAcrrY lC9 00 gal #OFCOMPARTMENTS_QL <br /> ❑ GREASETRAP TYPE/MFG L CAPACITY C. gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL 0 /T ft FOUNDATION ✓ / ft PROPERTY LINE l r {( <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 SS ft <br /> \ DISTANCE TO NEAREST WELL (90 , ft FOUNDATION IO , R PROPERTY LINE �0 r It <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL R FOUNDATION ft PROPERTY LUNE ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY UNE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH It <br /> DISTANCE 7 EST WELL R FOUNDATION It PROPERTY LINE It <br /> SEEPAGE PITS NUMBER WIDTH y a It ft DEPTH N2.15-A ft <br /> DISTANCE TO NEAREST WELL It FOUNDATION 56 ft PROPERTY UNE IBJ 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. p <br /> MINIMUM 48 HOUR ADVANCE FORINSPECTI -PLEASE CALL(209)953-7697 <br /> SIGNED TITLE DATE <br /> c MF�r <br /> > 0 <br /> PART f NT USE L 1208 <br /> I l F �Q <br /> Application Accepted �' V Date 7 7 ') Area Employee T^ <br /> Final Inspection By Date SPECIAL PER IT-Approved by �1 M �UNJ� <br /> Character of Soil to Dept*f3 Pt: Pit/Sump Soil Character: IT' 4 <br /> COMMENTS T1f`�T <br /> PE SC Received CheckM Amount Date Permit( Invoke# Permit ID# <br /> Code INFO BY Service Request# <br /> Z( 3 > 5 <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />