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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 73ve DEL TA .A dge. CITY/ZIP A Gc/ 9'.!;-76)4 <br /> CROSS STREET T-9� 14A(Mr- APN Z13-07,9- 30, 4( PARCEL SIZE 4n R G } <br /> 0 <br /> OWNER NAME /�� Vle F-AgMi g PHONE <br /> OWNERADDRESS 7300/ DF-ZT CITY/STATE/ZIP -fLACV _ <br /> CONTRACTOR C K E /t F-SY 1 0.-1 S Ute/LgTj1 A-1-6 PHONE 0 4 7(o <br /> CONTRACTOR ADDRESS Q K 3^^ ' �1/�+,/qs CITY/STATE/ZIP 7-k/L C D C I`4 � C Ac 9��8 <br /> LICENSE L.I I IC-42 ❑ IC-36 OTHER ACG /7`f// NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: �_1 ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # / BUILDING PERMIT SAND USE APPLICATION$1 <br /> TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION [ ENGINEER D IGNED/ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM L_ DESTRUCTION <br /> INSTALLATION WILL SERVE: 11 RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> Q SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ® GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> LJ LIFT STATION SIZE TYPE OF PUMP O PKG TX PLANT L3 SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> 0 LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> L3 FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> 0 MOUNDED WIDTH ft LE=NGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> I SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> El DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> C!' 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 /> MINIIb 48 H69 ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL 209 953-7697 <br /> SIGNED TITLE Cl V/L &6JIAlEG/2 DATE sz <br /> Elul <br /> C U <br /> I <br /> EaL <br /> E ARTMENT VSE (ALY <br /> Application Accepted By Date Area Employee ID# <br /> n - <br /> Final Inspection By Date b 1:1 SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 P' Sump Soil Character: <br /> COMMENTS - In <br /> PE SC Received Q h Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO By Cash Remitted Service Request# <br /> 3s > ?� •22• <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />