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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 />NUN-KEFUNDABBLE�PERMI/T p. �+ GALL (ZUUY)Y53-7697FOR <br />pINSPECTIONS c� EXPIRES 1 YEAR FROM DATE ISSUE <br />JOB ADDRESS 7 / -14- - S a 1-.3 E - C 1 c F-d%t E G/'"'- CITY/LIP 5tDQ--rb-m) q S-'L� <br />CROSS STREET ,./ W I L- rm�����M+ /APN 6O-2- /T 0\-�-1- -34 PARCELSIZE <br />OWNERNAME Y O -SlE -�-1 GD,,jrr7yC-nON ( JoSE VL-L-!)A)l 4 PHONE Z -ie- 3ob9 <br />OWNER ADDRESS 54 `o F 5r.CITY/STATE/ZIPgftw-Tik- C.r <br />CONTRACTOR G-IlVE c MC G -co EA-1!)(Lon/Wltr&j jitI- PHONE 3t / -03-1�- G cG <br />CONTRACTOR ADDRESS q01 I'1% ' a'Ood- ST . CITY/STATE/ZIP L(7D ( C^ 7 <br />LICENSE ❑ L C-42 ❑i'C-36 OTHER C 2-(5-1 t CT NUMBER EXPIRATION DATE 4 -.?c) F <br />� q <br />J <br />WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br />PERC TEST #_____L_ BUILDING PERMIT # LAND USE APPLICATION # <br />TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION G ENGINEER DESIGNED/ALTERNATIVE <br />.... REPLACEMENT ..: OUT -OF -SERVICE SEPTIC SYSTEM c DESTRUCTION <br />INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br />NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br />❑ SEPTIC TANK TYPEIMFG CAPACITY gal # OF COMPARTMENTS <br />❑ GREASE TRAP TYPE/MFG CAPACITY gal # OF COMPARTMENTS <br />DISTANCE TO NEAREST: WELL ft FOUNDATION It PROPERTY LINE ft <br />❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) <br />❑ LEACH LINES <br />L:1 LEACHING CHAMBERS <br />Received Che #/ <br />#OF LINES <br />Permit/ <br />LENGTH OF LINES ft <br />INFO <br />DISTANCE TO NEAREST <br />WELL <br />Service Request # Invoice # Permit ID# <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ FILTER BED <br />WIDTH <br />ft <br />LENGTH <br />ft <br />DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE ft <br />❑ MOUNDED <br />WIDTH <br />ft <br />LENGTH <br />ft <br />DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />It PROPERTY LINE ft <br />❑ SUMPS - <br />WIDTH <br />ft <br />LENGTH <br />ft <br />DEPTH It <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE It <br />❑ DISPOSAL PONDS WIDTH <br />ft <br />LENGTH <br />ft <br />DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft FOUNDATION <br />ft PROPERTY LINE It <br />❑ SEEPAGE PITS <br />NUMBER <br />WIDTH <br />ft DEPTH ft <br />DISTANCE TO NEAREST <br />WELL <br />ft 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 REGULATIONS OF SAN JOAQUIN COUNTY. <br />I�� A 4 <br />■■■■■�i�■■■■■1\■■■■\\■■■■\■■■■■■■■ ■■■ <br />DEPARTMENT U E ONLY r I, <br />Application Accepted -B^y � � �� 1, Date O Area "/ G Employee ID# 1rC?Vl R G. <br />Final Inspection By 44 S Date 9-1 - u ❑ SPECIAL PERMIT - Approved by <br />Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br />COMMENTS 10te 1�tfc 3/• rw k <br />PE <br />SC <br />Received Che #/ <br />Amount <br />Permit/ <br />Code <br />INFO <br />B Cash <br />Remitted Date <br />Service Request # Invoice # Permit ID# <br />9aa <br />42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />4/14/18 <br />