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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 AtlYtJ UJ 300 0 K4$SO , k� /Cm/ZIP T I�Ao�.f A 9 <br /> CROSS STREET II bLtw mU1. J APN FO I1(�0O PARCEL SIZE ijA 0 <br /> OWNER NAME An01re"i V r '�t/P.� ('� PHONE 4 <br /> OWNER ADDRESS(' 300 W/��,,,'-3(7g IC 6)�� `� CITY/STATE/ZIP f G 5 <br /> CONTRACTOR Jaen-L 61, 11/C (� n PHONE -7 <br /> CONTRACTOR ADDRESS IY 313 �wad(JZ 1 2) CITY/STATE/ZIP <br /> LICENSE 0:1C-42 El 7C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: IPS T1401 )0 ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION /EI^ iJ REPAIRIADDITION _ ENGINEER DESIGNED/ALTERNATIVE <br /> A REPLACEMENT Ie hGH C IGS ❑ OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: M RESIDENCE ❑ COMMERCIA Nd Y t rd r O OTHER <br /> h OO�NS FJ <br /> NUMBER OF LIVING UNITS: � NUMBER OF BEDROOMS: NBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPEIMFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFTSTATION SIZE TYPE OF PUMP ❑ PKGTXPLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES G LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION It PLINE ft <br /> ROP <br /> FILTERBED WIDTH IS ft LENGTH �D ft DEPTH ft <br /> DISTANCE TO NEAREST WELL I1 ft FOUNDATIONSO5ft t PROPERTY LINE 1 1 u S ft <br /> ❑ MOUNDED WIDTH It LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It <br /> ❑ SUMPS WIDTH It LENGTH It DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH It DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY UNE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION It 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 /> MINI UR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 9;Q2-769 <br /> SIGNED TITLE DATE Z ( <br /> Li <br /> 7 V1 <br /> —T owl), <br /> ----It <br /> Nr <br /> DEP ARTMEN US ONLY r <br /> Application Accepted By "� ��� Date Area J `�Cl Employee ID# <br /> Final Inspection By Date ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to De of 3 vi7v I P" Sump Soil Character: <br /> COMMENTS F6 lure J Py if niag does n-1- ry ,I e num er <br /> oF bcxc*aa►nS. S;aeC'/ �r ),edrmms per Gfln�-ac�rf �d so;), �lc�.� 6� 3 <br /> Qr t 1 <br /> PE SC Received Che Amount Date P rmiU Invoice# Permit ID# <br /> Code INFO B ashj Remitted Service Re uest# <br /> 3� <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />