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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 CALL(209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS /4 CITY' <br /> /ZIP ���✓ ii G; v <br /> CROSS STREET J 7� APN D �'l�V 3L PARCEL SIZE - <br /> / <br /> OWNER NAMEt/nCti1 Gam, �.. S : L, PHONE <br /> OWNER ADDRESS <br /> �y� >C;Yli,t _ CITY/STATE/ZIP <br /> CONTRACTOR /' J I �Z /�, �: jr� - r PHONE 4 <br /> CONTRACTOR ADDRESS Sn 1 ;x� j:^ CITY/STATE/ZIPi�h'�!'i�*4 <br /> LICENSE 0! 'C-42 ❑I.0-36 OTHER NUMBER EXPIRATION EXPIRATION DATE0rr <br /> WATER TABLE DEPTH: F ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST #IM t3r I BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: _ NEW INSTALLATION REPAIR/ADDITION LI ENGINEER DESI NED/ALTERNATIVE, <br /> REPLACEMENT I OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTIO <br /> INSTALLATION WILL SERVE: L4RESIDENCE ❑ COMMERCIAL If OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: 7 'y NUMBER OF EMPLOYEES: <br /> /) <br /> SEPTIC TANK TYPE/MFG PTL-y CAPACITY gal C�L> gal #OF COMPARTMENTS_ <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL�`7 ft FOUNDATION �) 1 ft PROPERTY LINE- j I 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 LIN ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH IV ED ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINPur 2 24ft <br /> 13SEEPAGE PITS NUMBER WIDTH ft DEPTH J 1.U149 ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPER VI COU ft <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY4r �ES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM 48 OUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL 209 953-7697 <br /> SIGNED TITLE DATE <br /> )fEPARTMEIVT LASEO LY <br /> If /Application Accepted By Date �� Area Employee ID# <br /> Final Inspection By Date L] SPEC ALP MIT-Approved by <br /> Character of Soil to Dep h of 3 Ft: Pi ump Soil Character: <br /> COMMENTS '���//V�i/7� <br /> e&fn <br /> PE SC Received < Che Amount Permit/ <br /> ode INFO B Cash emitted Date Service Request# Invoice# Permit ID# <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />