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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 C CALL 209 953-7697 FOR INSPECTIONS / E <br /> XPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS l L c7`' o f ITY/ZIIP/ L <br /> CROSS STREET ���1"+K-4U�l�J APN O 51 / '� `� PARCEL SIZE Z <br /> d <br /> /e ` d <br /> OWNER NAME .1/l�fr� /e eTeJi o �������� Z PHONE m <br /> OWNER ADDRESS [/ / CITY/STATE/ZIP t� <br /> CONTRACTOR f I q l2 [l/J/'1'I/A � �"/ � PHONE <br /> CONTRACTOR ADDRESS 3 LJ ((.c LC4�''C-G++ -(/ ,e.- // CITY/STATE/ZIP <br /> LICENSE ❑;I(C-42 ❑ C-36 OTHER NUMBER 4601 S EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> E PERC TEST # BUILDING PERMIT# f3p 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 E COMMERCIAL L OTHER <br /> NUMBER OF LIVING UNITS: /, , NUMBER OF BEDROOMS: 3 NUMBER OF EMPLOYEES: <br /> ,rk <br /> SEPTIC TANK TYPE/MFG Cv J�3 C CAPACITY l�10t!7 gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL 3Ce- 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 15-5- ft <br /> / <br /> DISTANCE TO NEAREST WELL 300 ft FOUNDATION �G ft PROPERTY LINE / 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 ft FOUNDATION ft PROPERTY LINE ft <br /> ' SEEPAGE PITS NUMBER2 <br /> - WIDTH ✓CL, 11 ft DEPTH o9, / ft <br /> DISTANCE TO NEAREST WELL 3CC ft FOUNDATION C.; 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 l TITLE DATE C, �f i <br /> jt n <br /> 114 U <br /> 1 <br /> U N(.oIjNTY <br /> E I O M ENT <br /> H <br /> DEPARTMENT USE ONLY <br /> Application Acceptedpy <br /> `1 '1 / yj Date 0 7 i` Area Employee ID# �\> <br /> Final Inspection By Date L SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS <br /> PE SC Received Check#/ Amount Permit/Co-7d�e INFO ash Remitted Date Service Request# Invoice# Permit ID# <br /> �0- L � O1 t_ <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />