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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 209 953-7697FOR INSPECTIONS EXPI <br /> RE <br /> S 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 3`5711 JAM I(r CGT. CITY/ZIP �Ct"C�f �+9� y2y <br /> CROSS STREET E V N l cc APN O O s- 3-sic,— w PARCEL SIZE 2_ A-c p <br /> r 0 <br /> OWNER NAME P��'T ft" �S G -�-�eV'PY1 Mor r 1>�12 PHONE (s716) 3�-''&,4 S y <br /> OWNER ADDRESS �y CITY/STATE/ZIP <br /> CONTRACTOR LE;E; O A`yl�r t7C.CEAJVI�'�� �N�A L PHONE -3�1-0 7_ S p, <br /> CONTRACTOR ADDRESS W /rV A� �r' CITY/STATE/ZIP <br /> LICENSE *C-42 Eli C-36 OTHER C G NUMBER Z 1 1 EXPIRATION DATE 14—3 0—iZ <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION fl ENGINEER DESIGNED/ALTERNATIVE <br /> _. REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM la DESTRUCTION <br /> INSTALLATION WILL SERVE: J RESIDENCE E COMMERCIAL OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG 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 /> ❑ 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 It 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 /> MINIMLIM,41 JIOUR ADVANCE NOTICE RE IRED FOR INSPECTIONSD -PLEASE CALL 2 953-ZU7 <br /> SIGNED TITLE rQ-aJ• ✓�G'R DATE 1?•�1 Z V <br /> RF Y�F�vr <br /> oe <br /> ®? 20 <br /> RON N COU <br /> OFpgR��ry <br /> l DEPARTMENT USE ONLY <br /> Application Acceptei Date 3 1 d „,D,,, Area % Employee ID# <br /> / <br /> Final Inspection By Date I 40 L6I�+ ] SPECIAL PERMIT-Approved by <br /> Character of Soil�D_ep�thA of 3 Ft: Pi ump oil Ch r <br /> COMMENTS 1J J 4� � 1r&i C filt1I412 <br /> PE SC Received Chec Amount Date Permit/ Invoice# PermitID# <br /> Code INFO ash Remitted Service Request# <br /> `I30 533 IS IZ2 ZO <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />