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ONSF E WASTEWATER TREAT EENT SYSTEM PERMI 1f` <br /> S;'0i 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 ExPPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS p 7 62 w -'y . r ILIO CITY/ZIP AA ed � <br /> CROSS STREET .��� F�/ j�� APN 1 j (r PARCEL SIZE <br /> �d <br /> OWNER NAME_.-.AS /ir/Al e-q&4. j�j^ A',A ��h PHONE y <br /> OWNER ADDRESS Q70 j �-aw fR� CITY/STATE/ZIP � (II� b / cyt CJ { <br /> CONTRACTOR S 1��--9TCxk'wT Sef PHONE Lim <br /> CONTRACTOR ADDRESS J ��k C szz CITY/STATE/ZI <br /> P G/1 twL4 <br /> LICENSE 11❑C-42 110C-36 OTHER--A NUMBER&6&q&qEXPIRATION DATE �B <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION REPAIR/ADDITION ❑ g:.IJGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ OUT-OF-SERVICE SEPTIC SYSTEM P",DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> V'01S //��EPTIC TANK TYPE/MFG T'd-L, CAPACITY l L as gal #OF COMPARTMENTS_ <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE TO NEAREST: WELL l ' ft FOUNDATION 31ft PROPERTY LINE L(6l 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 An " ft LENGTH LisI ft DEPTH 18'11 ft <br /> DISTANCE TO NEAREST WELL 10(� ft FOUNDATION (6� t ft PROPERTY LINE__6' ft <br /> ® MOUNDED WIDTH It LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> pl 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 /> Il 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 HQURIADVANCE NOTICE REQUIRED FOR INSPECTIONS- PLEASE CALL (209)953-7697 <br /> SIGNED TITLEyOn'I•/�Q C-14i { DATE s to a0 ab <br /> wl <br /> ,ccM <br /> C� <br /> U � <br /> E �. <br /> I DEPARTMENT USE ONLY <br /> Application Accepted By v Date1poiump <br /> Z� Area Employee ID# Dc4�I Gl <br /> Final Inspection By ( Date2 ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil Depth of 3 Ft: Soil Character: <br /> COMMENTS > er�tiG �ec�dl-Sr <br /> PE SC Received Check Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO By 4S Remitted Service Re uest# <br /> aioIps 300 X10- op <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />