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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 u /f ,, 9 /CALL 2,09 953-7697 FOR INSPECTIONS jyC E <br /> XPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS �//fir/ I�VA k)j:z �lq /4 l/�. CITY/ZIP <br /> CROSS STREET ((IcS� �_r/0 07t /yP APN?� a I r PARCEL SIZE J p <br /> OWNER NAME ��-///�/l� n`Gn PHONE <br /> OWNER ADDRESS L(O '"V/ LC,1` /�/ %/` 5 r' CITY/STATE/ZIP/�/� /�y/'•�/�(G//�/ � i <br /> Lr7 <br /> CONTRACTOR PHONE ?% 7�}�- <br /> CONTRACTOR ADDRESS CITY/STATE/ZIP /\7 UN C f?, �f 7_� ,k <br /> LICENSE ❑f IC-42 LINC-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 Il ENGINEER DESIG ED/A ERNATI <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: X RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: 5 NUMBER OF EMPLOYEES: <br /> SEPTIC TANK TYPE/MFG CAPACITY BOO!/ 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 /> 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 /> MINIMUM AB HO��UR ADVANCE NOTICE REQUIRED FOR INSPECTIONS -PLEASE CALL 209 953-7697 <br /> SIGNED LG�-� GG�L TITLE [IW,4 62� DATE L 45� <br /> OX <br /> N 2019 <br /> r <br /> o F °4Nry <br /> FNT <br /> EPARTMENT S Y Ajo <br /> Application Accepted By toArea EmpVID# O14�* <br /> Final Inspection By I c Date L ❑ $PECI PERMIT-Approved by <br /> Character of Soil to epth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS ��f J �� '�O (%,? �J iL I O L UUS U <br /> PE SC Received Chec Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO B y� s Remitted Service-Request# <br /> �` V � • � � IVI G <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />