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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 GALL (2118) 853-769/ FOR INSPECTIONS J t tXPIRES 11 /YEAR FROM DATE ISSUE <br />JOB ADDRESS Ae L W rv*TTEM2 � �b CITY21P i P -E -,C 4 CAVAP f 9S2-31 <br />CROSS STREET I✓Ac-KnIN LZ�- y APN 93-310 -CPARCEL SIZE '0 ' <br />OWNER NAME VV\ `�V-ik N'P4 A19-it"0 Jl� ( C -V0- kJ A V MZ -F-0 PHONE '244-911-2- <br />OWNER ADDRESS S ?vVY\f:r CITY/STATE/ZIP <br />CONTRACTOR 1,1 V C ,TlCitR`<-y �C Lt,3 V 19 ON iv1 �n�T �L PHONE 3&q -031 S Q <br />CONTRACTOR ADDRESS 'L 1 W iJ�� ST • CITY/STATE21P L-Ot> 1 CA 'iS-)-q0 <br />LICENSE L'...'C-42 11, .. C-36 OTHER C E: U NUMBER Zf 5 EXPIRATION DATE T -.3 0 <br />2 Z <br />WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br />❑ LEACH LINES <br />PERC TEST # <br />I BUILDING PERMIT # <br />LENGTH OF LINES ft <br />LAND USE APPLICATION # <br />TYPE OF WORK: <br />NEW INSTALLATION _ <br />REPAIR/ADDITION <br />I.] ENGINEER DESIGNED/ALTERNATIVE <br />❑ FILTER BED <br />WIDTH <br />_ REPLACEMENT <br />OUT -OF -SERVICE SEPTIC <br />SYSTEM 1..1 DESTRUCTION <br />INSTALLATION WILL SERVE: RESIDENCE <br />D COMMERCIAL <br />❑ OTHER <br />ft FOUNDATION <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: <br />❑ MOUNDED <br />NUMBER OF EMPLOYEES: <br />❑ <br />SEPTIC TANK <br />TYPE/MFG <br />CAPACITY <br />gal # OF COMPARTMENTS <br />❑ <br />GREASE TRAP <br />TYPE/MFG <br />CAPACITY <br />gal # OF COMPARTMENTS <br />ft LENGTH <br />DISTANCE TO NEAREST: WELL <br />It FOUNDATION <br />ft PROPERTY LINE ft <br />❑ <br />LIFT STATION <br />SIZE TYPE OF PUMP <br />❑ PKG TX PLANT <br />O SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />❑ LEACH LINES <br />LEACHING CHAMBERS <br /># OF LINES <br />LENGTH OF LINES ft <br />L as a <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ FILTER BED <br />WIDTH <br />It LENGTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE It <br />❑ MOUNDED <br />WIDTH <br />ft LENGTH <br />It DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ SUMPS <br />WIDTH <br />ft LENGTH <br />ft DEPTH It <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ DISPOSAL PONDS WIDTH <br />ft LENGTH <br />ft DEPTH It <br />DISTANCE TO NEAREST <br />WELL <br />It FOUNDATION <br />ft PROPERTY LINE ft <br />❑ SEEPAGE PITS <br />NUMBER <br />WIDTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />It FOUNDATION <br />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 <br />REGULATIONS OF SAN JOAQUIN <br />COUNTY. <br />MINIMUM 48 <br />HOUR ADVANCE NOTICE <br />RE <br />IRED FOR INSPECTIONS <br />- PLEASE CALL 209) 953-7697 <br />SIGNED <br />TITLE P'2 UJ • <br />IV1 &-f''-- DATE nl 36' <br />DEPARTMENTUS q ONLY C <br />Application Accepted By/�Z—<- Date 30Area f Employee ID#� <br />Final Inspection By Date L d 6(�- , ❑ SPECIAL PERMIT - Approved by <br />Character of Soil to De h 3 Ft: f , Pi ump Soil C ratter: <br />COMMENTS 4.7 L T/1 1. Cit - 1Ak) QA -t- 1- FL P � r If - yvr,u <br />w• VVI, <br />o 'Al (tt <br />PE <br />Code <br />SC Received Check # <br />INFO <br />Amountto Permit/ <br />Remitted Service Request # <br />Invoice # Permit ID# <br />L as a <br />s -a 3 <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4/14/18 <br />P7 - <br />Ir <br />