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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 t CALL 209 953-7697 FOR INSPECTIONS EXP RES 1 YEAR FROM DATE ISSUED <br /> JOBADDRESS •1 C. 1 CITY/LP V <br /> Q , y� � <br /> CROSS STREET -•�— APN U 0 S e 3 0--/ I PARCEL SIZE . 53 <br /> D <br /> v <br /> OWNER NAME C. PHONE <br /> OWNER ADDRESS �JQ CIIT/STATE/LP /�1 Q, [ <br /> CONTRACTOR ;L 1' U 1�j , I�r 11\\nn' 1.'HONE 'S(�lVL}�/�+ — T/w <br /> CONTRACTORADORESS y� �Zc•C\\'CCi /{. '`'1Vc. CITY/STATE/AP ILCl I�I.L1l`:a�U♦ <br /> LICENSE 5_C-42 \[-C-36 C-36 OTHER NUMBER 7,V7dY,3FXPIRATION DATE <br /> WATER TABLE DEPTH: It GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # r BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION i REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE FI COMMERCIAL F1 OTHER <br /> NUMBER OF LMNG 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 It FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFTSTAT10N SIZE TYPE OF PUMP ❑ PKGTXPLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES /U ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ FILTERBED WIDTH It LENGTH ft DEPTH It <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It <br /> ❑ MOUNDED WIDTH ft LENGTH It DEPTH ft <br /> DISTANCE TO NEAREST WELL It FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH It DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE It <br /> ❑ DISPOSAL PONDS WIDTH It 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 /> I HEREBY CERTIFY THAT 1 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 48 HOUR ADVANCE NOTICE RE UIRED FOR INSPECTIONS-PLEASE CALL 20 953-7697 , <br /> SIGNED TITLE ("I n Y' DATE <br /> IYMENT <br /> CEIVED <br /> 2 5 2019 <br /> Q1 COUNTY <br /> -VONMENTAL <br /> ARTMEN <br /> DEPARTMENT <br /> Application Accepted B Date Area Employee ID#��C►– <br /> Final Inspection By CA Date Y❑ SPECI PERMIT-Approved by <br /> Character of Soil to of 3 Ft: PiUS fi oil Character: <br /> COMME TS <br /> PE SC Received Check#/ Amount Permit/ <br /> Code -INFO— B Cash ernitted Date Service R uest# Invoice# Permit ID# <br /> 0 C1 3 2 0 25 <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/16 <br />