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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 /> JOB ADDRESS J Le 2eZCITY/ZIP <br /> :i <br /> FJ <br /> CROSS STREET J y APN 05519 Ga3 PARCEL SIZE <br /> OWNER NAME <br /> PHONE <br /> OWNER ADDRESS `I, CITY/STATE/ZIP <br /> ) J J J <br /> CONTRACTOR /7 1 f!�/"jh�\n /yYN� J ✓.G 4 eoJ z' - P H 0 N E <br /> CONTRACTOR ADDRESS L� / ����/��� 4�� —CITY/STATE/ZIP �fb� ��/ u 7�, %����✓ <br /> n �j 11 0 <br /> LICENSE ❑LIC-42 ❑I.1C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: �6�2 b ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: / NEW INSTALLATION ❑ REPAIR/ADDITION I] ENGINEER DESIGNED/ALTERNATIVE <br /> El REPLACEMENT n OUT-OF-SERVICE SEPTIC SYSTEM ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE 31d, COMMERCIAL ❑ OTHER <br /> NUMBER.OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: 31 IPC U[1111s <br /> fi J <br /> SEPTIC TANK TYPE/MFG Y CAPACITY 442� gal #OF COMPARTMENTS2� <br /> ® GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION )�' ft PROPERTY LINE <br /> C� LIFT STATION SIZE TYPE OF PUMP LSI PKG TX PLANT 13 SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> l� LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES /yD J ft <br /> DISTANCE TO NEAREST WELL ol?,5 ft FOUNDATION, "C? �� ft PROPERTY LINE f� 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 /> D 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 /> MIN 48 HQUR,,WANCEAV0T10E REQUIRED FOR INSPECTIONS -PLEASE CALL 209 953-7697 <br /> SIGNED TITLE �J � DATE <br /> J J <br /> i CUn <br /> 10T <br /> 7� <br /> DEPARTMENT,UE ONLY <br /> Application Accepted <br /> By /�-� Date 4 Is�o110 Area �� Employee ID# <br /> Final Inspection By A Date ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit Su p Soil Character: <br /> COMMENTS W gfejC4ier <br /> Geivkh 6r- �ferch gird Sb-'l eTapr. -Cie V 6 'mVA r 00 <br /> r619� � <br /> PE Sc Received Check#/ Amount D e Permit/ Invoice# Permit ID# <br /> Code INFO A J4.4 C sh Remitted lo Service equest# <br /> 9,q) asp �So <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />