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r 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 .— <br /> n CJ / CALL(209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS y! t. C�ILw�K' ELZ CITY/ZIP Zll <br /> CROSS STREET uAWit APN QZI, 01�- O PARCEL SIZE <br /> OWNER NAME .� PHONE y <br /> CA <br /> J <br /> OWNER ADDRESS 'IN�G CITY/STATE/ZIP <br /> CONTRACTOR �1 /CGf -/1�L PHONE ?�GJ S_CJZ� <br /> CONTRACTOR ADDRESS CITY/STATE/ZIP =. <br /> LICENSE [14 -42 ❑F!C-36 OTHER NUMBER_ �U�/S-EXPIRATION DATE <br /> ` r T <br /> WATER TABLE DEPTH:�i>•I 1 ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION REPAIR/ADDITION I I ENGINEER DESIGNED/ALTERNATIVE <br /> L REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM I ! DESTRUCTION <br /> LINSTALLATION WILL SERVE: l RESIDENCE I-I COMMERCIAL c ❑ OTHER <br /> NUMBER OF LIVING UNITS: I NUMBER OF BEDROOMS: 7 NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG _,c.� CAPACITY Zile, 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 0 PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> LEACH LINES 0",LEACHING CHAMBERS 3� #of LINES_ _ LENGTH OF LINES_ ft <br /> DISTANCE TO NEAREST WELL 494)t ft FOUNDATION S�I 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 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL 209 953-7697 <br /> SIGNED TITLE L�79�l�c�rsL DATE <br /> �Nr <br /> Fo <br /> F o101419 <br /> � Nry <br /> R <br /> T <br /> E P A R T M E N T L&S Ei ONLY <br /> Application Accepted ByDate. C7 Area ! ( Employee ID# <br /> Final Inspection By Date r/ ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pi Sump Soil Character: <br /> COMMENTS a pa' (MP <br /> PE SC Received Che Amount Date Permit/ Invoice# Permit ID# <br /> CodeINFO BV Remitted Service Request# <br /> �3o�'�� �� $ 2M <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4114/18 <br />