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ti <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 186E 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 /> JOB ADDRESS51 <br /> CROSS STREET �Q C� APN Dz3-t5?qb-/.3 PARCEL SIZE �Y Z"[ Y <br /> OWNER NAME 4Lj!ndh/C !fg4��� <br /> D ONElw <br /> OWNER ADDRESS /C❑0^ lyQ C y�,.< Cm E/ZIP/STAT �t Gbr CAP 9"rz� <br /> CONTRACTOR •L rf s� I PHONE �[O-/'ALL •r�O/F/ <br /> CONTRACTOR ADDRESS -V' Seo CnY/STATEZ <br /> /,�}y P <br /> LICENSE ❑\f-42 O_C-36 OTHER NUMBER -/O'IY 1/ E)"UTION DATE <br /> WATER TABLE DEPTH: It GEOGRAPHICAL INFORMATION: Coordinates 7t y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: _ NEW INSTALLATION REPAWADDTIION = ENG84EER DESIGNED/ALTERNATIVE <br /> - REPLACEMENT J OUT-0FSERVICE SEPTIC SYSTEM _ DESTRUCTION r\ <br /> INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTHER ��\J <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG IW&kACAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCETONEAREST: WELL ft FOUNDATION ft PROPERTY LINE <br /> ❑ LIFT STATION SIZE TYPE OF PUMP O PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) ll'� <br /> LEACH LINES C LEACHING CHAMBERS #OF LINES LENGTH OF LINES p It 1 <br /> DISTANCE TO NEAREST WELL 00 It FOUNDATION I 5o It PROPERTY LINE <br /> ❑ FILTER BED WIDTH It LENGTH ft DEPTH ft ^ <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft❑ MOUNDED WIDTH ft LENGTH It DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH It C <br /> DISTANCE To NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH It DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FO NFATION ft PROPERTYLINE ft �T <br /> SEEPAGE PITS NUMBER WIDTH / ft DEPTH �S/ g <br /> DISTANCE To NEAREST <br /> Wal I D ft FOUNDATION__ICU ft PROPERTY LINEm ft <br /> I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTYORDINANCES. <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM 48 HOU DVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 <br /> SIGNED TITLE / DATE <br /> 414 P �y 2J2S <br /> QUIIy co <br /> 1VIwFIVT <br /> ------------------------------- <br /> � <br /> EPART� AjT <br /> DEPARTMENT SE NLY <br /> Application Accepted By Date Area _yA 4? Employee ID# � <br /> Final Inspection By Date ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS <br /> PE SC Received -46hecidll'- Amount Permit/ <br /> Code INFO By `Cash miffed Date Service Re uest# Invoice# Permit ID# <br /> 42-01 <br /> 4114/18 ONS(TE WASTEWATER TRTMNT SYSTEM PERMIT <br />