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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 > EXJPIRES 1 YEAR FROM DATE IS ED <br /> JOB ADDRESS <br /> �Oa 00 P�/ �' CITY/ZIP K/0dC kll L� U <br /> H <br /> t=1 <br /> CROSS STREET �� I C'� APN D�J vV PARCEL SIZE 7d� <br /> OWNER NAME U✓ I A0_ PHONE <br /> OWNER ADDRESS l� CITY/STATE/ZIP �j ? r� <br /> CONTRACTOR l►C/ VII PHONE <br /> C PHONE a0/ /�✓'�/� /� ��a / �L <br /> CONTRACTOR ADDRESS a31cV SOI/) )r CITY/STATEIZIP <br /> LICENSE 11 42 00C-36 OTHER NUMBER OSS EXPIRATION DATE �/ -��_�� <br /> WATER TABLE DEPTH: � ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# AND USE APPLICATION# UL <br /> TYPE OF WORK: NEW INSTALLATION U REPAIR/ADDITION ❑ ENGINEER. ICJp/ALTER A <br /> ❑ REPLACEMENT L1 OUT-OF-SERVICE SEPTIC SYSTEM ❑ DESTRUCTIOII£ QV/A1 <br /> INSTALLATION WILL SERVE: jj RESIDENCE ❑ COMMERCIAL ❑ OTHER LTH'Dp,, TAC <br /> NUMBER OF LIVING UNITS: 1 NUMBER OF BEDROOMS: //N NUMBER OF EMPLOYEES: <br /> SEPTIC TANK TYPE/MFG mtzNT <br /> �;yl�✓��ZP /& <br /> CAPACITY C eeq gal #OF COMPARTMENTS 12 <br /> (((❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELLjrt ft FOUNDATION 5 ft PROPERTY LINE �_ft <br /> Ll LIFT STATION SIZE TYPE OF PUMPL3 PKG TX PLANT m SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> Y/ 1 <br /> ❑ LEACH LINES x LEACHING CHAMBERS #OF LINES 2 LENGTH OF LINES n ft <br /> DISTANCE TO NEAREST WEL ft FOUNDATION 0 5- ft PROPERTY LINE <br /> ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO ZEST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> SLIMPS WIDTH ft LENGTH_/ 1 ft DEPTH_ ft <br /> DISTANCE TO NEAREST WELL 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 /> S NUMBER WIDTH fl DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION 00 � ft PROPERTY LINE �V � 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 `I$HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL (209)953-7697 <br /> SIGNED r TITLE �j/��C%/,fir DATE777 <br /> r r <br /> 1I RL <br /> G <br /> 5 <br /> EPARTME�A� <br /> Application Accepted By Datea Employee ID# <br /> Date 1 ❑ SPECI L PERMIT-Approved b <br /> Final Inspection By b1 Z N� Y <br /> Character of Soil to Depth of 3 Ft: PitlSump Soil Character: /� <br /> COMMENTS S ,Gr .s S 4O <br /> PE SC Received Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO as Remi a Service Re nest# <br /> z28� y <br /> c�.a <br /> 42-01 )—sq- <br /> �j�- / ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/24/12 (�K rr (� VV <br /> IOgi <br />