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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 ADDRESSr a GI - CITY/ZIP $TO C K7O/i 9So2 I a <br /> CROSS STREET T-OPPI AAJt2 /-A/ APN OR6- I C)- &') 1 PARCEL SIZE 07 4c- <br /> OWNER <br /> GOWNER NAME �S 4.All CARLOS /telCDRA PHONE ,20!2- <br /> OWNER <br /> 2O9-OWNER ADDRESS ,/� /. DQ D)( / CITY/STATE/ZIP 516c k-ro j f�A 9Sa ow <br /> CONTRACTOR �>'"y �j���� r�klS u z L •J <br /> / 4 PHONE.N:? ! 5j, <br /> � (h <br /> CONTRACTOR ADDRESS (2 , 5q!4t) �� q- CITY/STATE/ZIP ���/_�L� cA q,5 <br /> LICENSE ❑❑C-42 ❑❑C-36 OTHER [L ` . - NUMBER_ 7q EXPIRATION DATE/30/a <br /> WAT R TABLE DEPTH: � 75 ft GEOGRAPHICAL INFORMATION: Coordinates X / Y <br /> PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION U REPAIR/ADDITION U ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT ❑ 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 /> ❑ 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 LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH It DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ 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 /> MINIkIlliM 48 ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 209 953-7697 <br /> SIGNED TITLE L71VI L "jAjrA _ DATE <br /> L / <br /> NT <br /> - D <br /> T-J�+FTF.7TT7 - <br /> J O <br /> R O <br /> DEPARTMENT S ONLY 0 � � <br /> Application Accepted By � Date 3a alto Area `1 9C/ Employee ID# p/G TMENT <br /> Final Inspection By Date N, ('L, 1. LO1e ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft: Pit/Sump Soil Character: <br /> COMMENTS V _%,eKye '�`�i`„n 22 1'; ni� \' <br /> t-, <br /> 0\•t\ - %Zai Zi <br /> PE SC Receivedec Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO By Cash Remitted Service Request <br /> aaa s'a-3 0 <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />