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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT w <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 FO INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 1,0 ILL CITY/ZIP �]I�/CA I q Y Z <br /> CROSS STREET ✓`�L/ r((L' -� APN O� I �r 1 PARCEL SIZE ��•J <br /> ./ ^7 0 <br /> OWNER NAME I �(r+�n�� / Cl, 7 Q)j am I PHONE <br /> OWNER ADDRESS ?� O 0 ��'ty C.C�(-� L- <br /> i �[1 CITYISTATE/ZIQP <br /> CONTRACTOR S(�p/ 1 L Se rcj I Ccs c, /-l�7 PHONE <br /> CONTRACTOR ADDRESS PD n K CICITYISTATE/ZIP IV) ITOn/q GA"-?56 <br /> LICENSE C-42 C-36 OTHERa A Zi NUMBER 106 10}p(PIRATION DATE D'�.�` �-tJ Z7 <br /> _7 K <br /> WATER TABLE DEPTH: J �� ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ' ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT - VICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: 1KRESIDENCE COMMERCIAL /.J I OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: T NUMBER OF EMPLOYEES: <br /> SEPTIC TANK TYPE/MFG t c 15�,n�. CAPACITY gal gal #OF COMPARTMENTS 7 <br /> Ll GREASETRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFTSTATION SIZE -TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES LEACHING CHAMBERS #OF LINES 7- LENGTH OF LINES—�v^(y ft <br /> DISTANCE To NEAREST WELL !(. (" ft FOUNDATION 7 (ri ft PROPERTY LINE /(7 -T It <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> 11� ❑ 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 Wl— ft DEPTH_ ft <br /> DISTANCE To NEAREST WELL _It FOUNDATION It PROPERTY UNE_ 1t <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 ADIP CE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 953-7697 <br /> SIGNED TITLE ��� L DATE Z-! - C C� I <br /> RF Y�FNT <br /> C�jVZzo <br /> E TJHOA <br /> p°REgCO <br /> zt0N2rryr <br /> rMENT <br /> / DEPARTMENTU EONLY 1 <br /> Application Accepted By -L' � Date .:• � .�I Area "7 C1 C Employee ID# <br /> Final Inspection By Date SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> COw1MENTS, ,,c Ines �I I�I!^ X,5 f/n �7F5 8h��i/k rx j!;,?E t fFC' 1 p�' Ll <br /> St t <;I's I;2C ;, � Y fPc"2�rC S <br /> PE SC Received Check#/ Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO Cas Remitted Service Re uest# <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 ^ <br />