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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT P- <br /> SAN JOA014N COUNTY ENVIRONMENTAL HEALTH PARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 <br /> N214-REFUNDABLE PERMIT I S►q 3 CALL 209 953-7697 FOR INSPECTIONS 1 EXPIRES 11 YEAR FROM DATE ISSUED <br /> JOB ADDRESS I ` (� CITY21P ()C l c G Cif 7 L -10 <br /> CROSS STREET(l ^�'` 'l APN_U_6�O G _ _PARCEL SIZE o <br /> OWNER NAMES/ cJJ[A(MJr �\ v�`I1Z E of_ _ _ _PHONE <br /> OWNERADDRESS 1 )ISI ,. MKQ" CIU q 7,d _ -7 6 <br /> CRY/STATElZIP <br /> CONTRACTOR _ _ __ PHONE <br /> CONTRACTOR ADDRESS __ CITYISTATE/ZIP <br /> LICENSE O C42 U 'C-36 r1OTHER NUMBER _.._ __ E%PIRATION DATE___ _— <br /> WATER TABLE DEPTH: 1 v R GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> 1 PERC TEST N BUILDING PERMIT N. _ IV)_ LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION REPAmIADDITION ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT _ OUT-OFSERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: 7RESIDENCE I I COMMERCIAL 7 fl OTHER <br /> UMBER OF LIVING UNITS: NUMBER OF BEDROOMS:___ NUMBER OF EMPLOYEES: <br /> SEPTIC TANK TYPE/MFG P CAPACITY 12UU gal #OF COMPARTMENTS <br /> O GREASE TRAP TYPE/MFG _ CAPACITY gal #OF COMPARTMENTS ,1 <br /> DISTANCE TO NEAREST: WELL U V R FOUNDATION�._ it PROPERTY LINE V(, it <br /> ❑ LIFTSTATION SIZE TYPE OF PUMP O PKGTX PLANT O SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> p'/LEACH LINES LEACHING CHAMBERSf//G ��' #OF LINES. LENGTH OF LINES <br /> DISTANCE TO NEAREST WELL�vx it FOUNDATION IUX it PROPERTY UNE IIUy it <br /> ❑ FILTER BED WIDTH it LENGTH_ _— — _ R DEPTH ft <br /> DISTANCE TO NEAREST WELL _ 11 FOUNDATION _ R PROPERTY LINE it <br /> ❑ MOUNDED WIDTH it LENGTH ______ R DEPTH it <br /> DISTANCE TO NEAREST WELL N FOUNDATION -h PROPERTY LINE _ ft <br /> ❑ SUMPS WIDTH it LENGTH_ . ft DEPTH it <br /> DISTANCE TO NEAREST WELLIt FOUNDATION it PROPERTY LINE it <br /> ❑ DISPOSAL PONDS WIDTH _K LENGTH__.__ __- it DEPTH it <br /> DISTANCE TO NEAREST WELL __ R FOUNDATION it PROPERTY�X� ft <br /> a SEEPAGE PITS NUMBER WIDTHrr,, _�f S DEPTH <br /> DISTANCE TO NEAREST WELL--1-5-a— it FOUNDATION 0 X It PROPERTY UNE P it <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN <br /> JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br /> CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br /> WORKERS COMPENSATION LAWS. <br /> MI 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS/---PLEASE CALL 209 953-7617 , <br /> SIGNE /o.frt/� — -- TITLE_()U 1��1 _ DATE <br /> IH <br /> I <br /> I IF <br /> A <br /> Vy <br /> IEONLY 'yt <br /> Application Accepted Boofft- <br /> Date_ .1"�,, _ Area _1/��_ Employee IDN �4'n <br /> Final Inspection By DateC�/j, _ Li SPECIAL PERMIT-Approved by <br /> Character of Soil to Pit/Sump Soil Character: <br /> COMMENTS <br /> PE SC C Amount DatePermW Invoice N Permit ID# <br /> Code INFO Bv ash Remitted I IService Re uest# <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 5/5/17 <br />