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, 1 <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 PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRE 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS S ` CITY/ZIP rl? v <br /> CROSS STREET -�w �// G-G�"� APN V 6 �a PARCEL SIZE 1 p <br /> OWNER NAME R'-'f �ah �� G i c c y n PHONE m <br /> OWNER ADDRESS SLI yrre' CITY/STATE/ZIP <br /> //L/�, <br /> CONTRACTOR ` ' ry' , �Ipf� PHONE (A- <br /> LICENSE <br /> / <br /> CONTRACTOR ADDRESS ! (� C�/ /�-�+�/ � � CITY/STATE/ZIP 7/ L� <br /> LICENSE ❑*-42 111IC-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH:_ (OO_-70 ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION I 1 ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM i i DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: .✓' NUMBER OF BEDROOMS: 3 NUMBER OF EMPLOYEES: <br /> SEPTIC TANK TYPE/MFG ( '�jC/f✓ 4 L CAPACITY l W gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL l00 `)� ft FOUNDATION ®V , ft PROPERTY LINE ZP ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> r <br /> LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> \ DISTANCE TO NEAREST WELL /0 ft FOUNDATION .36 ' 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 PIEAREST WELL ft /FOUNDATION ft PROPERTY LINE ft <br /> X SEEPAGE PITS NUMBER ZA / WIDTH 7(5 ,/ ft DEPTH C95-1 ft <br /> DISTANCE TO NEAREST WELL S9 r ft FOUNDATION SO ft PROPERTY LINE / ft <br /> 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 C1/i CLf�a,� DATE <br /> V / <br /> N <br /> z—Z-- <br /> DEPARTMENT US2E ONLY /� <br /> Application Accepted y Date '71.1-0 Area Employee ID# �Yi <br /> Final Inspection By Date ?� C SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: k/Sump Soil Character: <br /> COMMENTS SeCond it <br /> PE SC Received Check# Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO By as Remitted Seryice Re uest# <br /> ya I l 1-7 2 s 84 G�3 <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />