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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 53-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS O VJ01 CITY/ZIP <br /> CROSS STREET �R��Zt'T�N�s M A P N 0 Z-/ PARCEL SIZE <br /> 0 <br /> ff�� 1' <br /> OWNERNAME HQ/J� VL&S 1 (A wayS PHONE <br /> OWNER ADDRESS I o y CITY/STATE/ZIP <br /> CONTRACTOR 1teDle ,*l-e. / Q ��t.fiC PHONE J-- <br /> �� � / / JQ��-• <br /> CONTRACTOR ADDRESS / t4 CITY/STATE/ZIP ///.I G'7• /J ���_ <br /> LICENSE ❑!FEC-42 ❑11C-36 OTHER NUMBERZ 3 —/JO EXPIRATION DATE JO �Z � <br /> WATER TABLE DEPTH:�'C� { ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> -0 -P ERC TEST # BUILDING PERMIT# SD LAND USE APPLICATION# <br /> TYPE OF WORK: 0 NEW INSTALLATION I REPAIR/ADDITION 1� ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT I., OUT-OF-SERVICE SEPTIC SYSTEM rl DESTRUCTION <br /> INSTALLATION WILL SERVE: 49 RESIDENCE I) COMMERCIAL G ❑ OTHER <br /> NUMBER OF LIVING UNITS: /f IN/U'MBER OF BEDROOMS: / NUMBER OF EMPLOYEES: �J <br /> SEPTIC TANK TYPE/MFG �4 �r(�i0r+/ CAPACITY D 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 LEACHING CHAMBERS F( le #OF LINES�_ LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELLl_70 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 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 5 ft DEPTH 'Z S— 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 J8 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 <br /> SIGNED TITLE DATE <br /> T�T <br /> .00 <br /> J <br /> y p M U <br /> 7 <br /> of <br /> 0 A R T M E N T i S E IdN <br /> Application Accepted By YIA Date Area Employee ID#� <br /> Final Inspection By Date jrfj ❑ SPE IAL PERMIT-Approved by <br /> Character of Soil to Dept of 3 Ft. Pi Sump Soil Character: <br /> COMMENTS y wf4�_ <br /> PE SC Received hec Amount Dat Permit/ Invoice# Permit ID# <br /> Code INFO B Cash Remitted Service Request# <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />