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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 IN PECTIONS /� EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS � 11 T Ln �S -�1^3�'GOS CITY/ZIP K G 30 <br /> LI <br /> CROSS STREET Z1 I-LJ• DK�Vri APN PARCEL SIZE '- <br /> c <br /> z <br /> OWNERNAME SEAGIO ZILLT <br /> p c PHONE(SIo� Sss- 7321 J <br /> OWNER ADDRESS � me-F}t) Aputo YD PA12k LAjA7 CITY/STATE/ZIP r QE MOIUT 649�S3�e <br /> CONTRACTOR SCLrtOPHONE <br /> CONTRACTOR ADDRESS CITY/STATE/ZIP <br /> LICENSE LT C-42 11 C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION J ENGINEER DESI ED/ LTERNATIVE <br /> REPLACEMENT ' OUT-OF-SERVICE SEPTIC SYSTEM f DESTRUCTION ui <br /> INSTALLATION WILL SERVE: I 1 RESIDENCE I I COMMERCIAL 11 OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ 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 /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft 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 /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> 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 /> jqWLAWM 49 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 <br /> SIGNED TITLE DATE <br /> DATE�F <br /> ENVIROM N A <br /> 9EIF I: <br /> EPARTMENT S E L <br /> Application Accepted By Date Area Employee ID#'d"� <br /> Final Inspection By L� Date ❑ SPE IAL P RMIT-Approved t <br /> Character of Soil to epth of 3 Ft: Pi Sump Soil Character: <br /> COMMENTS Z <br /> ( —F �C 0 2 110 -fo 4�a.-�L yr Ao4 co Rio <br /> .1319 <br /> %ddir? home (0Ae&tt b ,� ('�A P �Y l�l�'1 0 /�! �f vlM� a C %�/ <br /> PE SC Received Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO Ey Cash Remitted Service Request# <br /> 471 0-7 Z <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />