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071 <br /> ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOADUIN 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 /> JOB ADDRESS Z�S..__. 1'U' O _ __...._.CITY/ZIP_I" <br /> i p^/��.-� <br /> CROSS STREET —_-----_ _._._ APN,v Ll._�7 ..___-. PARCEL SIZE 77, c <br /> OWNER NAME ////�.L/L .._-��i'�- -R�/i'� _. PHONE_l�G]-71y' (SQyyc <br /> OWNER ADDRESS � 1, (1'(s'/QlG LodCITY/STATErzIPL/ rrntP-...._�i¢�.-.__.�__[_�-x� N <br /> CONTRACTOR- GJ9/ L �J� /+G._ _- PHONE__„_ -/'S�OZZ <br /> CONTRACTOR ADDRESS/�Q�SG�J�tJ /r. GG —CITY/STATE/ZIP <br /> LICENSE 1-1/-42 Li C^-36 OTHER NUMBER `O/ .EXPIRATION DATE�T' <br /> WATER TABLE DEPTH: ,J G ft GEOGRAPHICAL INFORMATION: Coordinates X <br /> I PERC TEST B BUILDING PERMIT# —LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION V__ REPAIWADDITION ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT I OUT-OF-SERVICE SEPTIC SYSTEM i_ DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL L OTHER <br /> NUMBER OF LIVING UNITS: �J NUMBER OF BEDROOMS: 3 NUMBER OF EMPLOYEES: <br /> ❑ SEPTICTANK TYPE/MFG GT/SIJ CAPACITY o gal N OF COMPARTMENTS___.__ <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY-_ gal N OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL ft FOUtIDATION it PHOPERIY LINE fi <br /> ❑ LIFT STATION SIZE TYPE OF PUMP _❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> a�LEACH LINES p+`LEACHING CHAMBERS N Or LINES LENGTH OF LINES /CLQ ft <br /> DISTANCE TO NEAREST WELL it FOUNDATION U' -ft PROPERTY LINE ft <br /> ❑ FILTER BED WIDTH it LENGTH fi DEPTH it <br /> DISTANCE To NEAREST WELL 1t FOUNDATION __ }t PROPERTY LINE it <br /> ❑ MOUNDED WIDTH it LENGTH it DEPTH ft <br /> DISTANCE To NEAREST WELL ft FOUNOAIION__ ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH It LENGTH _ ft DEPTH _ ft <br /> DISTANCE To NEAREST WELL __ ft FOUNDATION _ ft PROPERTY LINE fl <br /> ❑ DISPOSAL PONDS WIDTH it LENGTH_____ _ ___ fi DEPTH it <br /> DISTANCE TO NEAREST WELL ft FOUNDATION_ - ft PROPERTY LINE_— ft <br /> ❑ SEEPAGE PITS NUMBEq WIDTH ft DEPTH it <br /> DISTANCE TO NEAREST WELL it FOUNDAI ION ft PROPERTY LINE It <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 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 <br /> SIGNED TITLE_ C DATEZ / <br /> r _- - ./ - <br /> { -- - - - - - - --- <br /> I 'M 9 <br /> -74 <br /> lCP <br /> L <br /> 4 i i <br /> DE 91jTU E ONL PG <br /> Application Accept - �e�__ _ Date_. ' -t'� Area ,y__ Employee IDRG� j <br /> Final Inspection y Date/J �� Ci SPECIAL PERMIT-Approved by <br /> Character of Soil to De hof 3 Ft: ._ _r PitlSum Soil Chara ter: <br /> COMMENTS <br /> PE SC Received ec Amount Date Permit/ Invoice# Permit IDN <br /> Code INFO B Cash Remitted Service Request III <br /> 1133 e , k3 <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/24/12 <br />