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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT 0 <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL <br /> (209)953-7697 FOR <br /> INSPECTIONS EXPIRES C (ELX!PIVRz� <br /> E�/S 1`�YEAR FROM <br /> ROM�TJ� <br /> +DATE <br /> ATE ISSUED <br /> SSUED <br /> JOB ADDRESS �Y ).6�� hGraglen`V �/ � <br /> CROSS STREETh APN PARCEL SIZE <br /> OWNER NAME CK 7' He- PHONE ZOELI <br /> ^ <br /> OWNER ADDRESSLCITY/STATE/ZIP <br /> CONTRACTOR `Ce ra(ce c 6 ajo PHONE 16 6 -'S <br /> CONTRACTOR ADDRESS nK <br /> Q L 4�pCITY/STATE/ZIP K�� ItOn/ . GA 9J6�i <br /> LICENSE .. C-42 C-36 OTHER !a NUMBER �Ob lO}p(PIRATION DATE S-.31-.3' <br /> 1L� <br /> WATER TABLE DEPTH: I I h1 ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLA-� �j REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE COMMERCIAL I OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG I(A I,0 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 /> J4 LEACH LINES LEACHING CHAMBERS #OF LINES Z _ LENGTH OF LINES S'd I ft <br /> DISTANCE TO NEAREST WELL N A ft FOUNDATION I l) ft PROPERTY LINE S It <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH It <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE It <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 WELLft 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 /> MINIMUM 4 R ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 2 953-7697 <br /> SIGNED �—fj- <br /> TITLE �N (.7 DATE 7 —(� <br /> cFe��T <br /> s o / 190 <br /> Q�ZAV �1 <br /> Fp R�No uZ'Ty <br /> FNT <br /> DEPARTMENT.USE ONLY (� <br /> Application Accepted 8 / � Date 1, eta Area I Employee ID#._ A <br /> Final Inspection By. DateSPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: PiV um0 oil Character: <br /> r <br /> COMMENTS I ,,l�,r� s <�tm. L)w)re"' I - le Cotn a ;.n lr iiL— <br /> :7"' <br /> -- <br /> ��(.'1 ' : StfkJ,; to ofigz Ij A10 i-,relil (Or /}F 1-4 L5 <br /> PE SC Received Check#/ Amount ate Permitl Invoice# Permit ID# <br /> Code INFO B Cash Remitted Service Re uest# <br /> IIS 1 <br /> 42-01n /'/n' /- ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 /I(//?�' J• i ZF64,-3 3� <br />