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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 CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1/YEAR FROM DATE ISSUED <br /> JOBADDRESS 31066, S-Pari-I CITY/ZIP 7l�AG� 9S3o� <br /> m <br /> CROSS STREETDN A APN PARCEL SIZE SI o <br /> OWNER NAME ROS!'i .TEMMY Erzill <br /> SI41E PHONE oZ©7- <br /> OWNER ADDRESS r'3O(IO7 SO UTN Koim(< / CITY/STATE/ZIP T2AW CA 9,'-19 / <br /> CONTRACTOR CRES/�IF C01J UL C,, PHONE hoz-.4-O2 -16!5.L <br /> CONTRACTOR ADDRESS Yn�377 1 CITY/STATE/ZIP �G(JLLO t� Pel <br /> LICENSE [1-C-42 ❑LiC-36 OTHER NUMBER-,_EXPIRATION DATE�3D /n�a <br /> W TER TABLE DEPTH: /✓G o ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: 1 1 NEW INSTALLATION L REPAIR/ADDITION I I ENGINEER DESIGNED/ALTERNATIVE <br /> I I REPLACEMENT LI OUT-OF-SERVICE SEPTIC SYSTEM I I DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG 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 /> ❑ LEACH LINES ' LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION 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 NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL it 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 /> M M 48 DVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 <br /> SIGNED TITLE C 101- 47V4 IA165;P, DATE 7 a <br /> .14 CC <br /> r <br /> J <br /> y Vi <br /> EPARTF) USE NLY FMf <br /> Application Accepted Bafe II Area Employee ID41 <br /> Final Inspection By Date 2 v 11SP IAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS � /� <br /> J <br /> PE SC Received Check#/ Amount Permit/ <br /> Code INFO B emitted Date Service R uest# Invoice# Permit ID# <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />