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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 C LL 209 95 -7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS b CITY/ZIP Za n <br /> 1 CROSS STREET �A J(i APN I PARCEL SIZE <br /> OWNER NAME_ l'�/a yT�� `J C LSC Luz N� <br /> t <br /> h�/1fVI ,�„ PHONE <br /> OWNER ADDRESS 16 �/� C�f`} d, IL CITY/STATE-/ZIP s � <br /> CONTRACTOR PHONE <br /> CONTRACTOR ADDRESS CITY/STATE/ZIP <br /> LICENSE ❑[7C-42 ❑❑C-36 OTHER NUMBER EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: 0 NEW INSTALLATION I REPAIR/ADDITION I ENGINEER DESI ED/ALTERN E <br /> REPLACEMENT I OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: ❑ RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG 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 /> E3 LIFTSTATION SIZE TYPE OF PUMP L3PKG TX PLANT Z) SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> - - - --- -------- --- <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 <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ti ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH 19 <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH HEAIT RQ l <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY I INF 'ARTMC f <br /> ❑ SEEPAGE PITS NUMBER �� <br /> WIDTH ft DEPTH <br /> 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 /> MI IMUM 48 HOUR ADVAN NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL 209 953-7897 <br /> SIGNED U t' r� <br /> TITLE � U=' D TE i 2 <br /> D PARTM=SjEEN-1.Y <br /> Application Accepted By Date lot tArea Employee ID#� <br /> Final Inspection By Ll(i�/ Date , %G G C� ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to D pth of 3 Ft: Pit/ ump Soil Character: <br /> COMMENTS U� /'�jc� ( SK <br /> PE SC Received Check#/ Amount Permit/ <br /> Code INFO B Cash emitted D to Service Reguest# Invoice# Permit ID# <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />