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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN J01QUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> Joe ADDRESS /C) I/'E�-5T LO/tFM_"re'W'e- • —CITY/ZIP !t 70 <br /> CROSS STREET �C A-S S���� APN Z3f-40-193 PARCEL SIZE <br /> c <br /> p / c <br /> OWNER NAME Er A L ,cl LAMS LLL TPHONFaU!��f'S Z^¢SBS <br /> OWNER ADDRESSr <br /> / TL}a R_rO/t f-D• CITY/STATE/ZIP �l OGtCO'(-DSL 9�ld/ <br /> CONTRACTOR retN /Grin/Gr PHONE '-40 1-2- <br /> P, <br /> CONTRACTOR ADDRESS / • 19 'SP le_�794 CITY/STATE/ZIP -l'Ani-aCc GA TUBI <br /> LICENSE I C-42 i I C-36 OTHER RG� NUMBER 07S EXPIRATION DATE <br /> WATER TABLE DEPTH: ,1 R GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> PERC TEST # BUILDING PERMIT# LAND USE APPLICATION#T A <br /> TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: i RESIDENCE COMMERCIAL 1 i OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPEIMFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCETO NEAREST: WELL R FOUNDATION It PROPERTY LINE it <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES I LEACHING CHAMBERS #OF LINES LENGTH OF LINES it <br /> DISTANCE TO NEAREST WELL it FOUNDATION it PROPERTY LINE it <br /> ❑ FILTER BED WIDTH it LENGTH it DEPTH it <br /> DISTANCE To NEAREST WELL it FOUNDATION it PROPERTY LINE it <br /> ❑ MOUNDED WIDTH it LENGTH it DEPTH it <br /> DISTANCE TO NEAREST WELL it FOUNDATION it PROPERTY LINE R <br /> l"�I <br /> Li SUMPS WIDTH it LENGTH R DEPTH •f(, I61L�_ it <br /> DISTANCE TO NEAREST WELL K FOUNDATION it PROPERTY LINE ` it <br /> ❑ DISPOSAL PONDS WIDTH it LENGTH it DEPTH % It <br /> DISTANCE TO NEAREST WELL it FOUNDATION it PROPER�Ij LINE'it <br /> ❑ SEEPAGE PITS NUMBER.-_. WIDTH it DEPTH �it <br /> DISTANCE TO NEAREST WELL it FOUNDATION it PROPERYII( �rz��O__ R <br /> 1 HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDAN C'�9 SAN <br /> JOAQUIN COUNTY ORDINANCES,STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICET�ISE IS <br /> CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br /> WORKERS COM,PENSATION LAWS. <br /> MINI M 48 R ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 <br /> SIGNED TITLE C7�/iEi✓(ri.VEE1Z DATE IZ- / / <br /> If <br /> R <br /> 6 <br /> A <br /> .N C 7- <br /> o / <br /> S <br /> Q D <br /> ca <br /> EPARTMENTUSE ONLY 1 <br /> Application Accepted By Date Area � Employee ID# <br /> i <br /> Final Inspection By Date SPECIAL ERMIT-Approved by <br /> Character of Soil to DeptW4 3 Ft: PIVS mp Soil Character: <br /> COMMENTS <br /> PE Sc Received Amount Date Permit) Invoice# Permit ID# <br /> Code INFO PYA ash Remitted Service Request# <br /> 52 3 d7 LI-5-1 -1-113 ` rW-1061-1 i <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 5/5/17 <br />