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z 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 Y^''�] <br /> E,AR FROM DATE ISSUED <br /> JOB ADDRESS C I CITY/ZIP Lt C14 CIA <br /> CROSS STREET APN OC)-714 30V U PARCELSIZE_ a <br /> }t c r <br /> OWNER NAME �� '✓� J � PHONE ` <br /> OWNER ADDRESS �� CITY/STATEIZIP S I✓c +�.� <br /> CONTRACTOR��J 1��JT f��- 1� PHONE �l i�,��p�+I� 1Q/�l�y"1 <br /> CONTRACTOR ADDRESS /"1/� [(fit 1 G�q CITY/STATE/ZIP L"- `�•' `K 1 1 <br /> LICENSE ❑OC-42 ❑ C-36 OTHER I NUMBER V950 I EXPIRATION DATE ;� <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: _ NEW INSTALLATION _ REPAIRIADDITION �_� ENGINEER DESIGNED/A 7ERNATIVE <br /> REPLACEMENT `. OUT-OF-SERVICE SEPTIC SYSTEM A DESTRUCTION CI N <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ 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 it <br /> ❑ LIFT STATION SIZE TYPE OF PUMP O PKG TX PLANT 0 SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE It <br /> ❑ FILTERBED WIDTH ft LENGTH ft DEPTH It <br /> DISTANCE To NEAREST WELL fl FOUNDATION It PROPERTY LINE It <br /> ❑ MOUNDED WIDTH It LENGTH ft DEPTH ft <br /> DISTANCE To NEAREST WELL ft FOUNDATION ft PROPERTY LINE it <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH It <br /> DISTANCE To NEAREST WELL ft FOUNDATION ft PROPERTY LINE It <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH It DEPTH It <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 /> MINIMUM 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 <br /> SIGNED ) TITLE I���� DATE <br /> R gytii <br /> FB F® <br /> /10 <br /> 1 <br /> DEPARTMENTUS ONLY <br /> Application Accepted B^ v L Date R-/d Area e Employee ID# <br /> Final Inspection By Date ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Dap*11`81`3 Ft: P USump Soil Character: <br /> COMMENTS <br /> 2 LD�ofl�,� �F hl 1k twJYl }�1+IP (y1v 1 !S 11 / <br /> O L Wks <br /> PE SC Received Check Amount Dat Permit/ Invoice# Permit ID# <br /> Code INFO Remitted Servic w2atA <br /> �laa 1 o s )sa <br /> 42-0 <br /> P o' 1L I R" SITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />