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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 J / J JCALL(209)953-7697 FOR INSPECTIONS ExPIRES 1 YEAR FROMDATEISSUED <br /> JOB ADDRESS `��> ft [/" l do 'r b ZAI. CITY/ZIP C./� ]r! 4 <br /> CROSS STREET w��C I LSO APN -2 O PARCEL SIZE 0. <br /> OWNER NAME y u-Q. jA(,C_ xj l-e- `J PHONE 6,17 -L-.")3 7 i <br /> OWNER ADDRESS n-f q F•r lf"T��J CITYISTATE/ZIP ��C.�C 'o� ��Z I <br /> CONTRACTOR �PO���` * -��wJ� PHONE <br /> CONTRACTOR <br /> ADDRESS <br /> /U I / e.wVy. aj !/ CITY/STATE/ZIP <br /> LICENSE DDC-42 ❑I 1C-36 OTHER NUMBER / ryf3 EXPIRATION DATE 3 1 <br /> WATER TABLE DEPTH: r ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: Li NEW INSTALLATION V REPAIR/ADDITION I ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT I OUT-OF-SERVICE SEPTIC SYSTEM 1 1 DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE 11 COMMERCIAL 2 ❑ OTHER <br /> NUMBER OF LIVING UNITS: �NUMBER OF BEDROOMS: % NUMBER OF EMPLOYEES: <br /> LJ SEPTIC TANK TYPE/MFG _ 04"AA I 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 J' LEACHING CHAMBERS 15 �:— 4 #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL 7y/ ft FOUNDATION ft PROPERTY LINE ft <br /> // <br /> 40 FILTER BED WIDTH ! d ft LENGTH ``- d 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 �U ft LENGTHY Z ft DEPTH le ft <br /> DISTANCE TO NEAREST WELL &0 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 gOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL 209 953-7697 <br /> SIGNED TITLE DATE�4 / f <br /> J <br /> y /N <br /> F T <br /> N <br /> EE <br /> I Eli+ <br /> r E11 FM� <br /> PARTME T UA E NLY <br /> Application Accepted Py Date Area Employee ID#� <br /> Final Inspection yDate Cl SPECIAL PERMIT-Approved by <br /> Character of Soil toJla;"t�� <br /> th of 3 Ft: �,��Piitt Sump Soil Character: <br /> COMMENTS'f�.V J (bRtA44, 'G��," Misr, k& <br /> PE SC Received heck#/ Amount Permit/ <br /> Code INB Cas Remitted Date Service Request# Invoice# Permit ID# <br /> FO <br /> f I v 10545',008 I a (.0 <br /> 42-01 ONSITE WASTEWATER TRTNINT SYSTEM PERMIT <br /> 4/14/18 <br />