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4 <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 <br /> NONREFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR <br /> FROM DATE ISSUED <br /> JOB ADDRESS V���U l/� CITY/ZIP <br /> CROSS STREET J APN 14- O�Ob V 1-5- <br /> PARCEL SIZE <br /> �C1 <br /> OWNER NAME PHONE <br /> OWNER ADDRESS So C)o 60, � ��, CITY/STATE/ZIP � �U <br /> CONTRACTOR �7_t.L✓� �. t��r� PHONE L / k1 -G /,,J <br /> CONTRACTOR ADDRESS CITY/STATEIZIP <br /> LICENSE 1111C-4242 ❑OC-36 OTHER /,�� NUMBER-, Y62 EXPIRATION DATE <br /> WATER TABLE DEPTH:U�N �ft GEOGRAPHICA INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: U NEW INSTALLATION U REPAIR/ADDITION U . ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEME T ❑ OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> /7 <br /> SEPTIC TANK TYPE/MFG z CAPACITY Tc lj/Z_ gal #OF COMPARTMENTS <br /> ® GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS Ly <br /> DISTANCETONEAREST: WELL ft ft FOUNDATION �ft PROPERTY LINE T7�T ft <br /> Q LIFT STATION SIZE TYPE OF PUMP 0 PKG TX PLANT E2 SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> Q LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATIO _ ft PROPERTY LINE ft <br /> FILTER BED ,L WIDTH ft LENGTy ft DEPTH�h�2 ft <br /> 1200 4 DISTANCE TC4EAREST WELL ft FOUNDATION i O 'r ft PROPERTY LINE ft <br /> Q MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> Q SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft -- PROPERTY LINE A ft <br /> Q DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH C611 r& ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> Q SEEPAGE PITS NUMBER WIDTH ft DEPTH 1TV 14 '9ne.+ ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERT ft <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOA � <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. 4kTF{"Dep'-'Y y L <br /> M/IVIdVIU/VI OFI AD CE RE UIRED POR INSPECTIO S -PLEASE CALL 209 953-7697 <br /> SIGNED J TITLE ✓ DATE <br /> J <br /> ARTMENT UAE O Y <br /> Application Accepted By Date l Area Employee ID# <br /> Final Inspection By Date L Q ❑ SPEC AL PERMIT-Approved by <br /> Character of Soil to Dep h of 3 Ft: Pitt ump Soil Character: <br /> COMMENTS Q�� V�1�— S "� C� i� -1 -C 1n D 1AbA�c a IYU <br /> PE SC Received heck#/ Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO s emitted Service Re uest# <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/24,12 <br />