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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 22009 953-7697 FOR INSPECTIONS EXPIRESLI YEAR FROM DATE ISSUED <br /> JOB ADDRESS -s'J CITY/ZIP �S Z 14 <br /> a <br /> CROSS STREET Ero e APN 6,9 PARCEL SIZE d <br /> /� b <br /> OWNER NAME I�4 ' y4 j�T, PHONE <br /> OWNER ADDRESS ?go- <br /> /> (14vlVQYt Cre/li Qr/ CITY/STATEIZIP .Ca)DC•F I`_)q 17§a0- <br /> CONTRACTOR / //✓/�1/�s^ �(�/J7,�- � S�w��' PHONE � -,7I f— —4/J--S <br /> CONTRACTOR ADDRESS �4 14i 11 (, CITY/STATE/ZIP �.'r� J,S-.r-- <br /> LICENSE ❑OC-42 ❑CC-36 OTHER NUMBER?/) EXPIRATION DATE / 31 / -2 / <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> 7—P ERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> 0 REPLACEMENT ;7 -t-`moi OUT-OF-SERVICE SEPTIC SYSTEM A DESTRUCTION TGt 0 k <br /> INSTALLATION WILL SERVE: 9 RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> l <br /> SEPTIC TANK TYPE/MFG `�� C.�l�`�e>`C CAPACITY do j gal #OF COMPARTMENTS 2- <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL 'X5 O It FOUNDATION S ft PROPERTY LINE <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 ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE 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 4&IHOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL (209)953-7697 <br /> SIGNED TITLE ef0 ice' y^ DATE <br /> In <br /> O <br /> M 10 <br /> F <br /> DEPARTMENT U E ONLY T <br /> Application Accepted Date 10 S ;Ogo Area �� Employee ID# A <br /> Final Inspection By Date ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS -- f E'T)5 , ' 10i g"Cry XI-f-1 < -fe n <br /> Jill <br /> IL <br /> c'XL <br /> of <br /> gCodeINFO <br /> Received a Amount Date Permit/ Invoice# Permit ID# <br /> B Cash Remitted Service Re uest L--7-0p- 4356 V <br /> 42-01 © ��' _–" f I �I`� r�� ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/16 �/` W� tc l..{�&-A '1GB'- `(, <br />