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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 ,gyp EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS /A ' Z S 7 <br /> eoa yy0 O0 If CITY/ZIP PACy <br /> ZSR—" <br /> CROSS STREET 1�`-]J J APN F�,01011;_/ PARCEL SIZEyoo 56),A" d <br /> OWNER NAME 'gl.-CX Y C'OleI PHONE� J !po`J- 3��q <br /> p � <br /> OWNERADDRESS 1fi/ZS- ReAVIODU CC> CITY/STATE/ZIP 7-PAC-/0 CA <br /> CONTRACTOR 6w z'0&1w': fC PHONE <br /> CONTRACTOR ADDRESS CITY/STATE/ZIP <br /> LICENSE ❑❑C-42 ❑❑C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT#1,4y IDQW V LAND USE APPLICATION# <br /> TYPE OF WORK: )K NEW INSTALLATION ❑ R AIR/ADDITION ❑ ENGINEER DESIGNED IALTERNAliVE, <br /> ❑ REPLACEMENT ❑ OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: Z NUMBER OF EMPLOYEES: <br /> �L SEPTIC TANK TYPE/MFG CAPACITY_�, zbC> 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 Z 7—61 ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE S 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 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 HOUR ADV NCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953/--7697 <br /> SIGNED TITLE Y C iIJU�QJ� DATB <br /> ti <br /> T <br /> D <br /> t S N <br /> VIHE 4[t C ll TY <br /> © PA <br /> NT <br /> EPA RTMENT US ONLY <br /> Application Accepted B Date Area Employee ID# <br /> Final Inspection By Date Z422a SPE IAL 4RMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS't'r" /l/, " LfiaVz1C ��r— E"/6 <br /> PE SC Received hec Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO B ash Re 'to Service Request# <br /> yL <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />