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ONSII-E WAS]EWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 E MAIN STREET-STOCKTON CA 95202-(209)468.3420 <br /> NON-REFUNDABLEPERMIT CALL <br /> 209)953-7697 FOR INSPECTIONS TT EXP <br /> IRE <br /> S'I YEAR FROM DATE ISSUED <br /> JOB ADDRESS 11419 E. Com`�-rOGF-- t -D. CITY/LP <br /> 3 Etre E12 m <br /> CROSS STREET APN 00 -130-7 -r -S�- PARCEL SIZE //PU11//� AC <br /> OWNER NAME L-IJGI Pc Cs71 -I L—L-O �j• ` - '�I. { <br /> • PHONE_ <br /> OWNER ADDRESS 1'�1'--19, ��rL r �/1-�-y I'---`✓• � �--gyp,. CRY/$TATE21P �-'( j��N (� <br /> CONTRACTOR t-Iy E OAI-' l.Tl.���/���(�/�Or+I—J 1'�E1y 1 L- PHONE 319 ( -03-i'S !�' <br /> CONTRACTOR ADDRESS 44 0-+ w, o p r---- 3- CITY/STATEIZIP L 0�) CA L s-7-40 <br /> LICENSE QC-42 OC-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST # 3 BUILDING PERMIT# LAND USE APPLICATION# go 17Z <br /> TYPE OF WORK: ❑ NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPEIMFG 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 /> ❑ LIFTSTATION SIZE TYPE OF PUMP ❑ PKGTXPLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> O LEACH LINES 0 LEACHING CHAMBERS #of LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH It LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELLIt FOUNDATION ft PROPERTY LINE ft <br /> O MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELLR FOUNDATION R PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE R <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE R <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH It <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 /> IM U OUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED TITLE DATE <br /> /:. <br /> 137.07' <br /> 6 <br /> PAYMENT <br /> RECEIVE® <br /> y, w � C.,zE,y 16 2018 <br /> ' <br /> 284.46 <br /> m i `•� JOAQUIN COUNTY <br /> ENVIRONMENTAL <br /> aWEALTH DEPARTMENT <br /> /� BEFCHEft rtOM '4 t�\\ <br /> t <br /> Q-,-'DEPARTMENT,US� <br /> Application Accepted By Area Employee ID# <br /> Date l '(7 O <br /> Final Inspection By Date E] SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character. <br /> COMMENTS <br /> PE SC Received eSk#/ Amount Permit/Code INFO B Remitted Date Service Request# Invoice# Permit ID# <br /> 11222 (1/11jr? w07)0 OL-1(0 <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br />