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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAOUIN 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 ADDRESStt--�� QCITY//ZIP /�1,z- a <br /> CROSS STREET yy///7//J< /�G.Q APN U J O D b C)v LI L PARCEL SIZE S age <br /> OWNER NAME/!/L=j�l�/2 A S/f� PHONE 7251-- /O 57� 0 <br /> OWNER ADDRESS r4 01)le / CITY/STATE/ZIP/G !' rri <br /> CONTRACTOR fci'J7/,z / C�G� J�•/J/yL PHONE :36/- 7 G�7 <br /> CONTRACTOR ADDRESS _3��G /,� CITY/STATEIZIP <br /> LICENSE [D(C-42 ❑ C-36 OTHER NUMBER /V yS yU EXPIRATION DATE <br /> Gam' <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 ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: L NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPEIMFG_/_�r/y!iL/c- CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPEIMFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE {1 <br /> ❑ LIFT STATION SIZE TYPE OF PUMP O PKG TX PLANT 13 SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> 04,LEACH LINES _ LEACHING CHAMBERS #OF LINES 570 <br /> LENGTH OF LINES <br /> DISTANCE TO NEAREST WELL R FOUNDATION J 0 ft PROPERTY LINE S0 ft <br /> ❑ FILTER BED WIDTH It 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 it 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 R FOUNDATION ft PROPERTY LINE ft <br /> (( SEEPAGE PRS NUMBER Z WIDTH 3!0" It DEPTH S ft <br /> DISTANCE TO NEAREST WELL IS-U /- ft FOUNDATION JUO` ft PROPERTYLINE__SU R <br /> 1 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 /> 48 HOUR Ai2VANCE NOTICE REQUIRED FOR INSPECTI -PLEASE <br /> SIGNED �� TITLE `moi.Ypc DATE <br /> YM EDIT <br /> CEIVED <br /> 0 2 2020 <br /> AQUIN COUNTY <br /> -EMIRONMENTAL <br /> H DEPARTMENT <br /> PAR N iL NL Y <br /> Application Accepted B Z41� f�-�L�L� Date J� i i! Area Employee ID# <br /> Final Inspection By \` Date ` ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to D th of 3 Ft: PIt/Su p Soil Character: <br /> COMMENTS - 1�' S fP _ /Jb .-JQ� s �i 1'�'�+� � <br /> PE SC Received Check#/ Amount PermlU <br /> Code INFO Invoice# PermttlD#Cash Remitted Dat® Service R oast <br /> L-W)L S 3JJ T- <br /> T- <br /> 42-01 <br /> 4/14118 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />