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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468.1420 <br /> NON-REFUNDABLE PER�]MI(T� '.l CALL 2009)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS .�-1�tT 1 ll-' '77�' V N� .S I ► 0.4 G1 /G(/ Q�TTY-/ZIP /; <br /> CROSS STREET SJe,� ri ad lGO�t� APN [� �J �i.,�n Z 4 -,3 <br /> PARCEL SIZE �� Y <br /> 0 <br /> 0 <br /> z <br /> OWNER NAME �(, PHONE <br /> OWNER ADDRESS / QTYISTATEIZIP y /_ <br /> CONTRACTOR / �?L/ c�// PHONE �Q I 3<1 �/i��Q�✓ X <br /> CONTRACTOR ADDRESS J / �V— I'C4h Xillk- C,/��`�J CITYISTATEIZIP <br /> LICENSE V42 C-36 OTHER NUMBER `�X grEXPIRATION DATE <br /> WATER TABLES 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: t9 NUMBER OF EMPLOYEES: <br /> L <br /> ❑ SEPTIC TANK TYPE/MFG �t/S 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 ❑ PKG TX PLANT 0 SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES LEACHING CHAMBERS #OF LINES U LENGTH OF LINES I ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION C90 / It PROPERTY LINE 17 CIO ' ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH IT <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 It DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION It 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 /> 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 /> MINIMUM 48 HOUR ADVANCE UIRED FOR INSPECTIONS-ELEASE CALL(209)953-769 <br /> SIGNED TITLE DATE <br /> YMENT <br /> CEIVED <br /> 2 7 2021 <br /> QUIN COUNTY <br /> ONMENTgL <br /> DEPARTMENT <br /> 7_ - '"'DEPARTMENT USE ONLY <br /> Application Accepted iJ Date <br /> �� Area Employee ID# <br /> Final Inspection By Dated ) 7) -- SPECt1AL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: 1 Pitit/Stimp Soil Character: <br /> COMMENTS `��—rte• IwG - <br /> r <br /> PE SC Received Check#f Amount Permitf <br /> Code INFO joy CashRemitted Date Service R uest# Invoice# Permit IDN <br /> Zw <br /> 2_L4lg2 <br /> L7 <br /> 1 Z r <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />