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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 I . - CITY/ZIP L�J7 I <br /> -:I <br /> CROSS STREET 1L/V�� f� � APN Q PARCEL SIZE <br /> OWNER NAME \ [�1" � \"� U�� PHONI(?�'d <br /> OWNER ADDRESS / O 8 ox /��t�y�. n �,��,J CITY/STATE/ZIP 7 <br /> S�br�F/t- C(�15 �}U��pv C— <br /> CONTRACTOR <br /> CONTRACTOR �{ / , ICITY/STATE-171- <br /> LICENSE <br /> /+ <br /> CONTRACTTOOR ADDRESS ✓�C W ��LOE I, CITY/STATE/ZIP <br /> LICENSE //LAIC-42 ❑CIC-36 OTHER NUMBER J-� `� EXPIRATION DATE tJK� 2,2- <br /> WATER TABLE DEPTH: ` ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: A NEW INSTALLATION REPAIR/ADDITION [J ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT I OUT-OF-SERVICE SEPTIC SYSTEM ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: �RaESIDENCE ❑ COMMERCIAL / ❑ OTHER <br /> f NUMBER OF LIVING UNITS: �Vt N7` NUMBER OF B�6pROOMS:- NUMBER OF EMPLOYEES: <br /> -C1 SEPTIC TANK TYPE/MFG RW L Co4,11((A CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG _ CAPACITY �7 gal #OFCOMPARTMENTS <br /> gy� <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION 3� ft PROPERTY LINE 11 1 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 7� ft <br /> DISTANCE TO NEAREST WELL I ft FOUNDATION ft PROPERTY LINE I W ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE nn <br /> [3SUMPS WIDTH ft LENGTH ft DEPTH <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH f/ IR �IJA <br /> �� <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft <br /> ft PROPERTY LINE OFPg !�CftT <br /> �EEPAGE PITS NUMBER 3 WIDTH -� 4r-�/I ft DEPTH ,2-7 ff <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 /> MINIMOM 48 HQUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL 209 953-7697'�� <br /> SIGNED TITLE �' i� '/�� DATE <br /> Nor <br /> ti <br /> 1 <br /> I IT <br /> t}. <br /> i <br /> DEPARTMENT S E ONLY q <br /> Application Accepted By ` Date a �� Area qG Employee ID# L)A <br /> Final Inspection By Date ❑ SPECIAL PERMIT -Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS A)PtJ SFF— J�JPIl4 WJPIiIn 1.1�0 401 Pw Gownfy Ieli07GlS <br /> PE SC Received heck#/ Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO By as Remitted Service Request# <br /> L-►a 13 H 7 2 7—)13D 41 F9 act 2 1p S� <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />