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1 s <br /> 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 �7 CALL 209 953-769/7 FOR INSPECTIONS E'X'PIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 2-1 O0� `-� � ' D( t S���� CA CITY/ZIP 6 J<r(tLOIv U <br /> p n v5 2 t 1 Z <br /> CROSS STREET URN �111LYV 1�-7 APN 2 � � PARCEL SIZE p <br /> OWNERNAME �I�Q�L�- �U f.IJJ NSI lI 5 oj) <br /> PHONE 2 � r <br /> v, <br /> OWNER ADDRESS 711CITY/STATE/ZIP BScAlory <br /> CONTRACTOR RP{�L�bYkT/F' a 7T&f=0L-c 5 0?z;5LlZYU6 I rtvC PHONE -Z�Ci S��I �QL/S�O <br /> CONTRACTOR ADDRESS �y2S /��� SG1,O,OL y !Jy/� 7 , CITY/STATE/ZIP L C/'�� �-530 <br /> LICENSE Y' C-42 I IC-36 OTHER NUMBER 7 GA.J EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: I NEW INSTALLATION REPAIR/ADDITION I I ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM i i DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: BER OF EDROOMS: NUMBER OF EMPLOYEES: --�tl 0 <br /> lroDM <br /> L3 SEPTIC TANK TYPE/MFG (2 0o(- EA e �S �� CAPACITY Apo gal #OF COMPARTMENTS Z <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 ! 5 ft <br /> DISTANCE TO NEAREST WELL $"� ft FOUNDATION� PROPERTYLINE — 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 It 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 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 <br /> SIGNE TITLEDATE ?—�7�du, <br /> ti <br /> 4' �J <br /> O <br /> IN <br /> S <br /> N N <br /> it MAA 1309tk:e 4H� <br /> FI VT <br /> a M <br /> EPARTMENT USE ONLY <br /> Application Accepted By Date Area Employee ID# Q rl <br /> Final(Inspection By Date E SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Charac r: <br /> COMMENTS rJ t/Ir r � L <br /> l vtJ T <br /> �( oral <br /> PE SC Received Check#/ Amount Permit/ <br /> Code INFO B Cash Remitted Date Service Request# Invoice# Permit ID# <br /> p ZS1.0-70 S <br /> Ib'C-� : �t jlf C 5'/�ir-Q-,I"tK,- ;�S��t � r� ��O✓ p�x�� /!u �i iVlr(- p� D.. �ULr.I t, .� .s <br /> 42-01 CAOyu- <br /> l3lOZNSITE <br /> ZWOA§�TEWATERTRTM TSYSTEM PERMIT <br /> 4/14/18 k�� gJrmo � .i � OI <br /> t� t , (7-er <br /> y (L <br />