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e <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 <br /> /PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 1 1 li+ a Sr CITY/ZIP <br /> CROSS STREET CA r r 3I �/y�� APN t}I-I o�13'-a(.. PARCEL SIZE � <br /> V' - <br /> o <br /> OWNER NAME f—\Y� S C�,r'-t-S PHONE y <br /> OWNER ADDRESS .I �� a- ��C r �'��l� CITY/STATE/ZIP <br /> t �Q< t `,J ��p <br /> CONTRACTOR1 //�� `- S � PHONE <br /> � <br /> CONTRACTOR ADDRESS LZ']l� �Sc� CITY/STATE/ZIP <br /> LICENSE ❑11C-42 11❑C-36 OTHER NUMBER - EXPIRATION DATE AL <br /> WATER TABLE DEPTH: 120-30 ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# _ LAND USE APPLICATION# <br /> TYPE OF WORK: 1 100, <br /> NEW INSTALLATION I, r REPAIR/ADDITION ❑ ENGINEER DESIGNED/ LTERNATIVE <br /> �') ❑ 1 <br /> REPLACEMENT K OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION JGl 11 K <br /> INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> 01-`SEPTIC <br /> OF LIVING UNITS: NUMBER OF BEDROOMS: 13 NUMBER OF EMPLOYEES: <br /> 0 SEPTIC TANK TYPE/MFG 'i`L CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTJS' <br /> DISTANCE TO NEAREST: WELL � J) ft FOUNDATION �, ft PROPERTY LINE '10+ ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES R LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> FILTER BED WIDTH az' ft LENGTH ��I ft DEPTH 1&r1 ft <br /> DISTANCE TO NEAREST WELL C5,,- <br /> .11 ft FOUNDATION /0; ft PROPERTY LINE t0� 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 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 H AN E NOTICE RE IRED FOR INSPECTIONS- PLEASE CALL 2 9A3-7697 <br /> SIGNED1'4� TITLE Ciao-*ryz ff-S'r DATE <br /> N (/ <br /> Fyz- <br /> / DEPARTMENT USE ONLY <br /> ApplicationAccepted B C� �L Date 3 i/ d/ Area Al 7t4 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 SVSI°►1�1 �a ►�U�e �P���rc irlc, �y�}lig SSfi°l�, . /Ja �E�k GJ ;�17�n �e �/G�S gyp• <br /> F I1bctirds. <br /> PE SC Received (Check#0 Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO B Remitted §ervice Request# <br /> 3 oc) 1 I itVD <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />